Provider Demographics
NPI:1114571643
Name:MERCEDES ALICE, ARNP, LLC
Entity Type:Organization
Organization Name:MERCEDES ALICE, ARNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ALICE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:425-814-2045
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:98028-7949
Practice Address - Country:US
Practice Address - Phone:425-814-2045
Practice Address - Fax:425-814-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2085918Medicaid