Provider Demographics
NPI:1144258435
Name:NILES, NANCY L II (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:L
Last Name:NILES
Suffix:II
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 NE 125TH ST #90
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4357
Mailing Address - Country:US
Mailing Address - Phone:206-362-0035
Mailing Address - Fax:206-362-6927
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:SUITE 90
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:206-362-0035
Practice Address - Fax:206-362-6927
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017593174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1022425Medicaid
WA110018087OtherRR MEDICARE
WA1022425Medicaid
WAG000106548Medicare PIN