Provider Demographics
NPI:1942088604
Name:AVALOS, ALINA RENEE (RN 61314045)
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:RENEE
Last Name:AVALOS
Suffix:
Gender:F
Credentials:RN 61314045
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3218
Mailing Address - Country:US
Mailing Address - Phone:509-540-1166
Mailing Address - Fax:
Practice Address - Street 1:534 S 3RD AVE # B-101
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3177
Practice Address - Country:US
Practice Address - Phone:509-525-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61314045163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse