Provider Demographics
NPI:1689120271
Name:ERICKSON-WAYMAN, ALYSSA (NP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:ERICKSON-WAYMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2671 NE 46TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5041
Mailing Address - Country:US
Mailing Address - Phone:206-525-8000
Mailing Address - Fax:206-525-8070
Practice Address - Street 1:2671 NE 46TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-525-8000
Practice Address - Fax:206-525-8070
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341043-1363LF0000X
WAAP 60650389363LP2300X
UT11727972-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
WI331945Medicare Oscar/Certification
WI331944Medicare Oscar/Certification
WI331947Medicare Oscar/Certification
WI331954Medicare Oscar/Certification
WI331009Medicare Oscar/Certification
WI331946Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
WI331058Medicare Oscar/Certification
WI331952Medicare Oscar/Certification
WI331978Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY00695941Medicaid
WI331043Medicare Oscar/Certification