Healthcare Provider Details

I. General information

NPI: 1205220258
Provider Name (Legal Business Name): ALLISON REANNE WALCZYK ARNP, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 S J ST FL 5
TACOMA WA
98405-4930
US

IV. Provider business mailing address

1608 S J ST FL 5
TACOMA WA
98405-4930
US

V. Phone/Fax

Practice location:
  • Phone: 253-274-7505
  • Fax: 253-985-2853
Mailing address:
  • Phone: 253-274-7505
  • Fax: 253-985-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number307597
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61360876
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61360876
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: