Provider Demographics
NPI:1922447069
Name:NIZNIK, ROBERT STANISLAW (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STANISLAW
Last Name:NIZNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 BIRCHWOOD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1783
Mailing Address - Country:US
Mailing Address - Phone:360-734-9233
Mailing Address - Fax:360-738-8974
Practice Address - Street 1:410 BIRCHWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-734-9233
Practice Address - Fax:360-738-8974
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60296207R00000X
COTL.0004905390200000X
WAMD60890396207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2063556Medicaid