MEDICARE: ALICIA MOEZ WAYLAND FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95028442	CA

General Provider Information

NPI Number	:	1760251383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA MOEZ WAYLAND FNP-BC

Provider Business Mailing Address
First Line	:	1720 SW 4TH AVE APT 1609
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97201-5561
Country	:	US
Telephone Number	:	808-765-8204
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 KNOWLES DR STE 16
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-1448
Country	:	US
Telephone Number	:	408-374-1320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2023
Last Update Date	:	12/22/2023

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Directions to “ ALICIA MOEZ WAYLAND FNP-BC” Practice Location

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