Provider Demographics
NPI:1851935274
Name:NIEVES, JASON LUCAS (LPN)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:LUCAS
Last Name:NIEVES
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 172ND ST NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-7742
Mailing Address - Country:US
Mailing Address - Phone:360-572-3511
Mailing Address - Fax:360-654-0420
Practice Address - Street 1:5700 172ND ST NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-7742
Practice Address - Country:US
Practice Address - Phone:360-572-3511
Practice Address - Fax:360-654-0420
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60367576164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse