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Individual

KIM ELIZABETH PRUESS NEVINS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
450 NW GILMAN BLVD, SUITE 301A, ISSAQUAH, WA 98027-2483
(425) 391-0313
(425) 837-8501
Mailing address
PO BOX 1225, ISSAQUAH, WA 98027-0047
(425) 391-0313
(425) 837-8501

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00038616
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0160710
DEPT OF L & I
WA
01
110235772
RAILROAD MEDICARE
05
1116037
WA
01
6232PR
REGENCE BLUE SHIELD
WA
Enumeration date
01/18/2006
Last updated
05/31/2011
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