Provider Demographics
NPI:1891902318
Name:NICOLAYSEN, ANN (LMP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:NICOLAYSEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 1ST AVE W
Mailing Address - Street 2:STE. A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4156
Mailing Address - Country:US
Mailing Address - Phone:206-281-4282
Mailing Address - Fax:206-285-6854
Practice Address - Street 1:315 1ST AVE W
Practice Address - Street 2:STE. A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4156
Practice Address - Country:US
Practice Address - Phone:206-281-4282
Practice Address - Fax:206-285-6854
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006195225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANI5136OtherREGENCE BLUESHIELD
WA67669OtherLABOR & INDUSTIES