Healthcare Provider Details

I. General information

NPI: 1528649522
Provider Name (Legal Business Name): ALYSIA WASHINGTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13819 HANSON BLVD NW
ANDOVER MN
55304-7608
US

IV. Provider business mailing address

420 DELAWARE STREET SE MMC 913
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 855-324-7843
  • Fax:
Mailing address:
  • Phone: 612-624-0990
  • Fax: 612-625-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number78207
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036175960
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number78207
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: