Healthcare Provider Details

I. General information

NPI: 1497484802
Provider Name (Legal Business Name): HAZELINE VILLARUZ GUMIRAN-ALEJANDRO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 S 38TH CT
RENTON WA
98055-5894
US

IV. Provider business mailing address

714 S 38TH CT
RENTON WA
98055-5894
US

V. Phone/Fax

Practice location:
  • Phone: 206-372-2960
  • Fax: 425-282-4455
Mailing address:
  • Phone: 206-372-2960
  • Fax: 425-282-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP61317271
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: