Active NPI
Tepaporn Nishimura, REGISTERED NURSE
- Registered Nurse
- Renton, WA
National Provider Identifier
1487045290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN60017388
- Practice address
- 16022 116TH Ave SE
Renton, WA 98058-5245 - Phone
- (425) 204-3352
- Fax
- (425) 204-3357
- NPI assigned
- Feb 16, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN60017388 | WA | Primary |
Addresses
Primary practice location
16022 116TH Ave SE
Renton, WA 98058-5245
Mailing address
264 Vashon Ave NE
Renton, WA 98059
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 231428 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN60017388 | WA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424044800000",
"number": "1487045290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "264 VASHON AVE NE",
"city": "RENTON",
"state": "WA",
"postal_code": "98059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16022 116TH AVE SE",
"city": "RENTON",
"state": "WA",
"postal_code": "980585245",
"telephone_number": "425-204-3352",
"fax_number": "425-204-3357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NISHIMURA",
"first_name": "TEPAPORN",
"name_prefix": "Mrs.",
"credential": "REGISTERED NURSE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-02-16",
"last_updated": "2015-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WA",
"license": "RN60017388",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "231428",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Renton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.