Individual
VERNON NESSAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
702 23RD AVE SE, PUYALLUP, WA 98372-4661
(253) 841-4378
(253) 841-5881
Mailing address
PO BOX 40, PUYALLUP, WA 98371-0137
(253) 697-5502
(253) 697-5510
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
MD00013833
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0155123
L & I PROVIDER NUMBER
WA
05
—
1665702
—
WA
01
—
4330437
AETNA PROVIDER NUMBER
WA
01
—
91120349463
KPS PROVIDER NUMBER
WA
01
—
98372K003
TRICARE PROVIDER NUMBER
WA
01
—
NE2298
REGENCE RIDER NUMBER
WA
Enumeration date
05/27/2006
Last updated
07/08/2007
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