Healthcare Provider Details

I. General information

NPI: 1144566589
Provider Name (Legal Business Name): MS. ALANA G BOURES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15675 AMBAUM BLVD SW
BURIEN WA
98166-2523
US

IV. Provider business mailing address

2613 S 122ND ST
SEATTLE WA
98168-2413
US

V. Phone/Fax

Practice location:
  • Phone: 206-433-2413
  • Fax:
Mailing address:
  • Phone: 206-498-5158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP00031729
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberLP00031729
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: