Provider Demographics
NPI:1760251383
Name:WAYLAND, ALICIA MOEZ (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MOEZ
Last Name:WAYLAND
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 SW 4TH AVE APT 1609
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5561
Mailing Address - Country:US
Mailing Address - Phone:808-765-8204
Mailing Address - Fax:
Practice Address - Street 1:777 KNOWLES DR STE 16
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1448
Practice Address - Country:US
Practice Address - Phone:408-374-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily