Healthcare Provider Details

I. General information

NPI: 1972317204
Provider Name (Legal Business Name): ALTA SUPPORTIVE NURSING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 SE PIONEER WAY STE 201
OAK HARBOR WA
98277-3204
US

IV. Provider business mailing address

316 SE PIONEER WAY STE 290
OAK HARBOR WA
98277-5716
US

V. Phone/Fax

Practice location:
  • Phone: 360-682-9848
  • Fax: 620-646-9813
Mailing address:
  • Phone: 360-682-9848
  • Fax: 620-646-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LENA BRANSOM
Title or Position: OWNER
Credential: APRN
Phone: 360-682-9848