Individual
MARK NISHIYAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 S SCHEUBER RD, CENTRALIA, WA 98531-8877
(360) 330-8950
(360) 330-8955
Mailing address
1000 S SCHEUBER RD, CENTRALIA, WA 98531-8877
(360) 330-8950
(360) 330-8955
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD00039478
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87278418
—
WA
01
—
AB23193
MEDICARE GROUP
WA
Enumeration date
12/11/2006
Last updated
06/23/2021
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