Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP30001043 | WA |
NPI | 1043378490 |
---|---|
Provider Name | Mrs. Alicia Austria Paraiso |
First Address | Kent, WA 98042-6665 |
Second Address | Auburn, WA 98002-5404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9609587 | (05) | WA |
S73054 | (02) | WA |