Individual
ALYSSA GILLIAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13820 19TH AVE NE, TULALIP, WA 98271-6706
(425) 789-8340
Mailing address
13820 19TH AVE NE, TULALIP, WA 98271-6706
(425) 789-8340
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60682267
WA
Other
Enumeration date
10/17/2016
Last updated
10/17/2016
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