Provider Demographics
NPI:1861479404
Name:LASSILA, QUAHLEE DOLORES (FNP)
Entity Type:Individual
Prefix:MRS
First Name:QUAHLEE
Middle Name:DOLORES
Last Name:LASSILA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 LEUDINGHAUS RD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-9244
Mailing Address - Country:US
Mailing Address - Phone:360-520-4367
Mailing Address - Fax:
Practice Address - Street 1:158 LEUDINGHAUS RD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-9244
Practice Address - Country:US
Practice Address - Phone:360-520-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-24
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9645771Medicaid
WAP00294166OtherRAILROAD MEDICARE
WA9645771Medicaid
WAQ51159Medicare UPIN