Provider Demographics
NPI:1891290201
Name:NIMZ, REBECA MARIA (RN BSN)
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:MARIA
Last Name:NIMZ
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15530 NE KNOTT ST UNIT 35
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-8705
Mailing Address - Country:US
Mailing Address - Phone:503-927-4987
Mailing Address - Fax:
Practice Address - Street 1:6701 NE 78TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-0956
Practice Address - Country:US
Practice Address - Phone:971-570-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60460348163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse