Provider Demographics
NPI:1003184946
Name:NICULESCU, NONA (MD)
Entity Type:Individual
Prefix:
First Name:NONA
Middle Name:
Last Name:NICULESCU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NONA
Other - Middle Name:
Other - Last Name:FURCULITA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1200 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144
Mailing Address - Country:US
Mailing Address - Phone:425-744-7153
Mailing Address - Fax:425-755-7128
Practice Address - Street 1:1200 12TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2712
Practice Address - Country:US
Practice Address - Phone:425-744-7153
Practice Address - Fax:425-775-7128
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR161410207R00000X
WA60661489261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1003184946Medicaid
OR383993Medicare PIN
ORR170756Medicare PIN