Provider Demographics
NPI:1174184436
Name:MAZURINA, ALENA
Entity Type:Individual
Prefix:
First Name:ALENA
Middle Name:
Last Name:MAZURINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 W MAIN ST
Mailing Address - Street 2:STE 107, #314
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4232
Mailing Address - Country:US
Mailing Address - Phone:360-314-6000
Mailing Address - Fax:
Practice Address - Street 1:4555 NE 66TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3181
Practice Address - Country:US
Practice Address - Phone:360-314-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60869341164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse