Individual
NICHOL T IVERSON
Active
Individual
NICHOL T IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00014336
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111661087
MEDICARE OTHER-INDIVIDUAL
WA
05
—
1410802
—
WA
01
—
193400000X
TAXONONMY
WA
01
—
CO3401
MEDICARE OTHER-GROUP
WA
Enumeration date
02/09/2006
Last updated
02/28/2013
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