Individual
MRS. NICOLE PREVO KAGEYAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1412 SW 43RD ST STE 205, RENTON, WA 98057-4803
(425) 264-0660
(425) 264-0601
Mailing address
1200 112TH AVE NE, SUITE C-187, BELLEVUE, WA 98007
(425) 457-7900
(425) 457-7499
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD00046078
WA
207ND0900X
Dermatopathology Physician
MD00046078
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00301940
RAILROAD MEDICARE
WA
Enumeration date
06/01/2005
Last updated
09/07/2017
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