Provider Demographics
NPI:1386744324
Name:NILSON, REX Z (DPM)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:Z
Last Name:NILSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 216TH ST SW STE 320
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8006
Mailing Address - Country:US
Mailing Address - Phone:425-673-3900
Mailing Address - Fax:425-673-3910
Practice Address - Street 1:7320 216TH ST SW STE 320B
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-775-6996
Practice Address - Fax:425-670-8905
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000340213ES0103X
WAPO0000034O213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1004092Medicaid
WA81436OtherL&I
WA1009272Medicaid
WAPO0000034OOtherSTATE LICENSE
WAPO0000034OOtherSTATE LICENSE
WA000148802Medicare PIN
WAT02119Medicare UPIN
WA0338620001Medicare NSC