Provider Demographics
NPI:1033475348
Name:ALICE, MERCEDES MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:MARIE
Last Name:ALICE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18208 66TH AVE NE STE 201
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-7949
Mailing Address - Country:US
Mailing Address - Phone:425-814-2045
Mailing Address - Fax:425-814-2783
Practice Address - Street 1:18208 66TH AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028
Practice Address - Country:US
Practice Address - Phone:425-814-2045
Practice Address - Fax:425-814-2783
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60022966163WP0808X
WAAP60425457363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health