Provider Demographics
NPI:1801257043
Name:WINDHAM, ALIA MROWCZYNSKI (DAOM, LAC)
Entity type:Individual
Prefix:
First Name:ALIA
Middle Name:MROWCZYNSKI
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 N 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-6119
Mailing Address - Country:US
Mailing Address - Phone:530-394-4727
Mailing Address - Fax:
Practice Address - Street 1:185 CADILLAC PL
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4355
Practice Address - Country:US
Practice Address - Phone:530-394-4727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 16115171100000X
NV2054171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist