Provider Demographics
NPI:1427527233
Name:NINO, NIKKI LILLIAN (NP)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:LILLIAN
Last Name:NINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9819 HARBORVIEW PL
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-1018
Mailing Address - Country:US
Mailing Address - Phone:815-557-7970
Mailing Address - Fax:
Practice Address - Street 1:9819 HARBORVIEW PL
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-1018
Practice Address - Country:US
Practice Address - Phone:815-557-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60897315363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care