Provider Demographics
NPI:1598272221
Name:HEMMERSBACH, ALISA FAYE (ARNP)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:FAYE
Last Name:HEMMERSBACH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5512 ANTON CT SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5104
Mailing Address - Country:US
Mailing Address - Phone:360-584-8138
Mailing Address - Fax:
Practice Address - Street 1:5512 ANTON CT SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-5104
Practice Address - Country:US
Practice Address - Phone:360-584-8138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60822854363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA82-3403817OtherIRS