Healthcare Provider Details

I. General information

NPI: 1174184436
Provider Name (Legal Business Name): ALENA MAZURINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 NE 66TH AVE
VANCOUVER WA
98661-3181
US

IV. Provider business mailing address

2210 W MAIN ST STE 107, #314
BATTLE GROUND WA
98604-4232
US

V. Phone/Fax

Practice location:
  • Phone: 360-314-6000
  • Fax:
Mailing address:
  • Phone: 360-314-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP60869341
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: