Provider Demographics
NPI:1588205595
Name:NISHIMOTO, KYE
Entity Type:Individual
Prefix:MRS
First Name:KYE
Middle Name:
Last Name:NISHIMOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1200
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-1200
Mailing Address - Country:US
Mailing Address - Phone:253-241-1020
Mailing Address - Fax:
Practice Address - Street 1:5035 S ORCHARD ST APT A
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-3669
Practice Address - Country:US
Practice Address - Phone:253-241-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider