Individual
JOHN W NEMANICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4011 TALBOT ROAD SOUTH, SUITE 500, RENTON, WA 98055
(425) 251-5110
(425) 793-7376
Mailing address
PO BOX 59028, RENTON, WA 98058-2028
(425) 251-5110
(425) 793-4707
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD00022799
WA
207RI0011X
Interventional Cardiology Physician
MD00022799
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0057612
L&I
WA
05
—
1046820
—
WA
01
—
110056683
RR MEDICARE
WA
01
—
NE5890
REGENCE
WA
Enumeration date
10/25/2006
Last updated
01/28/2010
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