Provider Demographics
NPI:1548504491
Name:NELSON, ALANA (LMP)
Entity type:Individual
Prefix:
First Name:ALANA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9234
Mailing Address - Country:US
Mailing Address - Phone:253-508-2758
Mailing Address - Fax:
Practice Address - Street 1:1107 OAK ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9234
Practice Address - Country:US
Practice Address - Phone:253-508-2758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023125174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist