Provider Demographics
NPI:1710875257
Name:IBRAHIM, NISMA (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:NISMA
Middle Name:
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 SW SUNSET BLVD APT E401
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-6140
Mailing Address - Country:US
Mailing Address - Phone:714-483-2104
Mailing Address - Fax:
Practice Address - Street 1:2101 SW SUNSET BLVD APT E401
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-6140
Practice Address - Country:US
Practice Address - Phone:714-483-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95189029363L00000X
WARN61543424363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner