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General NPI Number Information
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NPI Number | 1972317204
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Entity Type | Organization
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Legal Business Name | ALTA SUPPORTIVE NURSING SERVICES PLLC
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 380 SE PIONEER WAY STE 201
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City | OAK HARBOR
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State | WA
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Zip | 98277-3204
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Country | US
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Telephone | 360-682-9848
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Fax | 620-646-9813
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Provider Business Mailing Address
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Address Line | 316 SE PIONEER WAY STE 290
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City | OAK HARBOR
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State | WA
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Zip | 98277-5716
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Country | US
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Telephone | 360-682-9848
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Fax | 620-646-9813
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Authorized Official
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Title or Position | OWNER
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Name | LENA BRANSOM
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Credential | APRN
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Telephone | 360-682-9848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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