Individual
AMIRA AMAR NYSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
1904 3RD AVE STE 252, SEATTLE, WA 98101-1194
(206) 682-1424
Mailing address
11501 5TH AVE NE, SEATTLE, WA 98125-6201
(206) 854-6268
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
MA60255405
WA
Other
Enumeration date
10/18/2012
Last updated
10/18/2012
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