Individual
MR. NICHOLAS PORTALSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1007 39TH AVE SE, PUYALLUP, WA 98374-2192
(534) 457-1002
Mailing address
1007 39TH AVE SE, PUYALLUP, WA 98374-2192
(208) 878-8783
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-1472
ID
363A00000X
Physician Assistant
Primary
PA60892458
WA
Other
Enumeration date
02/08/2017
Last updated
05/04/2021
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