Healthcare Provider Details

I. General information

NPI: 1750968368
Provider Name (Legal Business Name): ALISA BIEBER AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 12TH AVE
SEATTLE WA
98122-4411
US

IV. Provider business mailing address

901 12TH AVE
SEATTLE WA
98122-4411
US

V. Phone/Fax

Practice location:
  • Phone: 206-926-5660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61196687
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60865900
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: