Healthcare Provider Details

I. General information

NPI: 1063187920
Provider Name (Legal Business Name): ALEXIS ROSE HNATIAK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 LIBERTY DR
CLARKSTON WA
99403-2486
US

IV. Provider business mailing address

1030 LIBERTY DR
CLARKSTON WA
99403-2486
US

V. Phone/Fax

Practice location:
  • Phone: 478-550-5603
  • Fax:
Mailing address:
  • Phone: 478-550-5603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP.AP.70173501-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: