Provider Demographics
NPI:1437172947
Name:NIZZA, QUYNH-NHU PHAM (MD)
Entity Type:Individual
Prefix:MRS
First Name:QUYNH-NHU
Middle Name:PHAM
Last Name:NIZZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:QUYNH-NHU
Other - Middle Name:THI
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12800 BOTHELL-EVERETT HWY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6644
Mailing Address - Country:US
Mailing Address - Phone:425-316-5180
Mailing Address - Fax:
Practice Address - Street 1:909 N BROADWAY
Practice Address - Street 2:PBO CREDENTIALING
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1409
Practice Address - Country:US
Practice Address - Phone:425-317-0699
Practice Address - Fax:425-317-0291
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045858207Q00000X, 208D00000X
GA58998207Q00000X
PAMD427869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAI67295Medicare UPIN