Provider Demographics
NPI:1578936142
Name:PARKER, ALISHA VICTORIALEE (LMP)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:VICTORIALEE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12815 CANYON RD E
Mailing Address - Street 2:SUITE K
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-5786
Mailing Address - Country:US
Mailing Address - Phone:253-226-3847
Mailing Address - Fax:253-268-2057
Practice Address - Street 1:12815 CANYON RD E
Practice Address - Street 2:SUITE K
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5786
Practice Address - Country:US
Practice Address - Phone:253-226-3847
Practice Address - Fax:253-268-2057
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60230422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist