Individual
MR. NICHOLAS M REZEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
400 S 43RD ST, RENTON, WA 98055-5714
(425) 228-3450
Mailing address
25246 NETWORK PL, CHICAGO, IL 60673-1252
(425) 656-4255
(425) 656-4003
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004972
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0214542
LIWA
WA
01
—
3075RE
BSWA
WA
05
—
8442725
—
WA
Enumeration date
01/02/2006
Last updated
09/21/2011
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