Provider Demographics
NPI:1750585097
Name:ALFRED, SALLY HERNANDEZ (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:HERNANDEZ
Last Name:ALFRED
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:VERONICA
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:550 17TH AVE
Practice Address - Street 2:STE 680, 6TH FLOOR
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5788
Practice Address - Country:US
Practice Address - Phone:206-861-8550
Practice Address - Fax:206-861-8551
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167352363LF0000X
WAAP60254258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06695OtherGROUP PTAN
VAC06695OtherGROUP PTAN