Provider Demographics
NPI:1578685657
Name:RAMJI, NISHA PUNJANI (PA)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:PUNJANI
Last Name:RAMJI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15809 BEAR CREEK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-1542
Mailing Address - Country:US
Mailing Address - Phone:425-882-6100
Mailing Address - Fax:
Practice Address - Street 1:15809 BEAR CREEK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-1542
Practice Address - Country:US
Practice Address - Phone:425-882-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8478836Medicaid
WAG8809523Medicare PIN
WAG8867117Medicare PIN
WA8478836Medicaid