MEDICARE: MISS DAISY ABUTIN LALAS NURSE CASE MANAGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	RN00090507	WA

General Provider Information

NPI Number	:	1437817632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DAISY ABUTIN LALAS NURSE CASE MANAGER

Provider Business Mailing Address
First Line	:	16103 41ST AVE NE
Second Line	:
City	:	LAKE FOREST PARK
State	:	WA
Zip	:	98155-6725
Country	:	US
Telephone Number	:	206-331-2312
Fax Number	:	206-539-5713

Provider Business Practice Location Address
First Line	:	16103 41ST AVE NE
Second Line	:
City	:	LAKE FOREST PARK
State	:	WA
Zip	:	98155-6725
Country	:	US
Telephone Number	:	206-331-2312
Fax Number	:	206-539-5713

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2021
Last Update Date	:	12/04/2021

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