Provider Demographics
NPI:1033893763
Name:BERDIYEV, ALANA (NP)
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:
Last Name:BERDIYEV
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 ERICA DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8463
Mailing Address - Country:US
Mailing Address - Phone:206-601-5573
Mailing Address - Fax:
Practice Address - Street 1:35 S LOUISIANA ST STE A120
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8630
Practice Address - Country:US
Practice Address - Phone:509-491-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAF06230181363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty