Provider Demographics
NPI:1215424494
Name:BIDES, NERIO ARESTAN (RN)
Entity type:Individual
Prefix:
First Name:NERIO
Middle Name:ARESTAN
Last Name:BIDES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 SE 222ND ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-2546
Mailing Address - Country:US
Mailing Address - Phone:206-351-0615
Mailing Address - Fax:253-344-1724
Practice Address - Street 1:10200 SE 222ND ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-2546
Practice Address - Country:US
Practice Address - Phone:206-351-0615
Practice Address - Fax:253-344-1724
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60001992163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA461508884Medicaid