Healthcare Provider Details

I. General information

NPI: 1366172751
Provider Name (Legal Business Name): ALYSSA ULSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 YELM HWY SE
OLYMPIA WA
98501-4826
US

IV. Provider business mailing address

4420 HENDERSON BLVD SE UNIT 305
OLYMPIA WA
98501-4668
US

V. Phone/Fax

Practice location:
  • Phone: 360-507-8146
  • Fax:
Mailing address:
  • Phone: 435-730-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number10837256-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61456343
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: