Provider Demographics
NPI:1093197923
Name:WASTAK, ALLISON L (NP-C, RN, CCRN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:L
Last Name:WASTAK
Suffix:
Gender:F
Credentials:NP-C, RN, CCRN
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:SEIPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1910 OUTLET CENTER DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0677
Mailing Address - Country:US
Mailing Address - Phone:805-485-2400
Mailing Address - Fax:805-485-3025
Practice Address - Street 1:1910 OUTLET CENTER DR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0677
Practice Address - Country:US
Practice Address - Phone:805-485-2400
Practice Address - Fax:805-485-3025
Is Sole Proprietor?:No
Enumeration Date:2015-06-27
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093197923OtherVIRGINIA PREMIER HEALTH PLAN
VA1093197923OtherOPTIMA HEALTH
VA-029OtherTRICARE/CHAMPUS
VA1093197923OtherUSA MANAGED CARE
NC1093197923Medicaid
VA1093197923OtherCORVEL
VA1093197923OtherMULTIPLAN
VA1093197923Medicaid
VA1093197923OtherMULTIPLAN
VA-029OtherTRICARE/CHAMPUS