Provider Demographics
NPI:1104008457
Name:NIMICK, BETTINA (LMP)
Entity Type:Individual
Prefix:
First Name:BETTINA
Middle Name:
Last Name:NIMICK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 N OLYMPIC AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1245
Mailing Address - Country:US
Mailing Address - Phone:360-435-8490
Mailing Address - Fax:
Practice Address - Street 1:426 N OLYMPIC AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1245
Practice Address - Country:US
Practice Address - Phone:360-435-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018566225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist