Provider Demographics
NPI:1730895327
Name:ALFRED-IYAMU, OSAYANDE (NP)
Entity type:Individual
Prefix:
First Name:OSAYANDE
Middle Name:
Last Name:ALFRED-IYAMU
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 D PL SE APT 1
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-8696
Mailing Address - Country:US
Mailing Address - Phone:469-450-7164
Mailing Address - Fax:214-975-2617
Practice Address - Street 1:101 ELLIOTT AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4236
Practice Address - Country:US
Practice Address - Phone:425-678-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61680532363LP0808X
TX773088363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health