Healthcare Provider Details

I. General information

NPI: 1356259204
Provider Name (Legal Business Name): ALICIA LYNN LUNDQUIST HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 E COLONIAL AVE STE A
MOSES LAKE WA
98837-4644
US

IV. Provider business mailing address

827 E COLONIAL AVE STE A
MOSES LAKE WA
98837-4644
US

V. Phone/Fax

Practice location:
  • Phone: 509-765-4467
  • Fax: 509-764-0662
Mailing address:
  • Phone: 509-765-4467
  • Fax: 509-764-0662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number70114748
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: