Provider Demographics
NPI:1790826410
Name:RHYNARD, NICOLENE KNISKERN
Entity Type:Individual
Prefix:
First Name:NICOLENE
Middle Name:KNISKERN
Last Name:RHYNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLENE
Other - Middle Name:
Other - Last Name:KNISKERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5622 108TH PL SW
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-4654
Mailing Address - Country:US
Mailing Address - Phone:425-283-8163
Mailing Address - Fax:
Practice Address - Street 1:5622 108TH PL SW
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-4654
Practice Address - Country:US
Practice Address - Phone:425-283-8163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003849235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8451296Medicaid