Healthcare Provider Details

I. General information

NPI: 1033548326
Provider Name (Legal Business Name): ALISSA LONG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 120TH AVE NE
KIRKLAND WA
98033-8100
US

IV. Provider business mailing address

7210 120TH AVE NE
KIRKLAND WA
98033-8100
US

V. Phone/Fax

Practice location:
  • Phone: 360-434-7682
  • Fax:
Mailing address:
  • Phone: 360-434-7682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN00173561
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: