Provider Demographics
NPI:1073059259
Name:NIITSU, KOSUKE (PHD, ARNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:KOSUKE
Middle Name:
Last Name:NIITSU
Suffix:
Gender:M
Credentials:PHD, ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18115 CAMPUS WAY NE
Mailing Address - Street 2:BOX 358555
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011
Mailing Address - Country:US
Mailing Address - Phone:425-352-3183
Mailing Address - Fax:425-352-3581
Practice Address - Street 1:17927 113TH AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-7909
Practice Address - Country:US
Practice Address - Phone:425-352-3183
Practice Address - Fax:425-352-3581
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0000823-C-NP363LP0808X
IAG145896363LP0808X
NE111689363LP0808X
WAAP60989975363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health