Healthcare Provider Details

I. General information

NPI: 1285661744
Provider Name (Legal Business Name): ALESSA L LOPEZ-CASTOR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/18/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 31ST AVE NE STE 101
TULALIP WA
98271-7423
US

IV. Provider business mailing address

6330 31ST AVE NE STE 101
TULALIP WA
98271-7423
US

V. Phone/Fax

Practice location:
  • Phone: 360-716-2200
  • Fax: 360-716-2211
Mailing address:
  • Phone: 360-716-2200
  • Fax: 360-716-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60420859
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: