Provider Demographics
NPI:1497484802
Name:GUMIRAN-ALEJANDRO, HAZELINE VILLARUZ (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:HAZELINE
Middle Name:VILLARUZ
Last Name:GUMIRAN-ALEJANDRO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 S 38TH CT
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5894
Mailing Address - Country:US
Mailing Address - Phone:206-372-2960
Mailing Address - Fax:425-282-4455
Practice Address - Street 1:714 S 38TH CT
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5894
Practice Address - Country:US
Practice Address - Phone:206-372-2960
Practice Address - Fax:425-282-4455
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61317271363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology