Healthcare Provider Details

I. General information

NPI: 1922915859
Provider Name (Legal Business Name): ALICIA REAUME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 MARVIN RD NE
LACEY WA
98516-3138
US

IV. Provider business mailing address

2555 MARVIN RD NE
LACEY WA
98516-3138
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-4200
  • Fax:
Mailing address:
  • Phone: 360-413-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.RN.70113858.
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: