Healthcare Provider Details

I. General information

NPI: 1093197923
Provider Name (Legal Business Name): ALLISON LYNN WASTAK NP-C, RN, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON SEIPP

II. Dates (important events)

Enumeration Date: 06/27/2015
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 OUTLET CENTER DR
OXNARD CA
93036-0677
US

IV. Provider business mailing address

1910 OUTLET CENTER DR
OXNARD CA
93036-0677
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-2400
  • Fax: 805-485-3025
Mailing address:
  • Phone: 805-485-2400
  • Fax: 805-485-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172720
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: