Provider Demographics
NPI:1134455546
Name:MYSIEWICZ, ALPHONSE MICHAEL (RN)
Entity type:Individual
Prefix:
First Name:ALPHONSE
Middle Name:MICHAEL
Last Name:MYSIEWICZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 17TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3012
Mailing Address - Country:US
Mailing Address - Phone:206-280-0293
Mailing Address - Fax:
Practice Address - Street 1:2200 6TH AVE
Practice Address - Street 2:SUITE 828
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1896
Practice Address - Country:US
Practice Address - Phone:206-448-3255
Practice Address - Fax:800-882-7527
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00103964163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse