Healthcare Provider Details

I. General information

NPI: 1730909250
Provider Name (Legal Business Name): ALEJANDRA O RAMOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DALE AVE
BENTON CITY WA
99320-5250
US

IV. Provider business mailing address

701 DALE AVE
BENTON CITY WA
99320-5250
US

V. Phone/Fax

Practice location:
  • Phone: 509-588-4075
  • Fax:
Mailing address:
  • Phone: 509-588-4075
  • Fax: 509-588-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP61591750
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: