Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | AP60515716 | WA |
N | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | AP60515716 | WA |
NPI | 1053715169 |
---|---|
Provider Name | Alisha Halverson Wilkes |
First Address | Renton, WA 98059-7231 |
Second Address | North Bend, WA 98045-8191 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2014 |
Last Update Date | 18/07/2016 |