Provider Demographics
NPI:1598398059
Name:LANE, ALYSSA ROSALIE IRENE (RN, PHN)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ROSALIE IRENE
Last Name:LANE
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2592 KWINA RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9278
Mailing Address - Country:US
Mailing Address - Phone:360-312-2000
Mailing Address - Fax:360-384-2336
Practice Address - Street 1:2592 KWINA RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9278
Practice Address - Country:US
Practice Address - Phone:360-312-2000
Practice Address - Fax:360-384-2336
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60637630163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN60637630OtherWA STATE LICENSE NUMBER