Provider Demographics
NPI:1164812798
Name:NIEMI, PAUL (ARNP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:NIEMI
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 TALBOT RD S STE 500
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5704
Mailing Address - Country:US
Mailing Address - Phone:425-690-3493
Mailing Address - Fax:425-690-9493
Practice Address - Street 1:4033 TALBOT RD S STE 500
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5704
Practice Address - Country:US
Practice Address - Phone:425-690-3493
Practice Address - Fax:425-690-9493
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60497652363LC0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2043223Medicaid