Individual
MS. ALYSIA I. PRIVRAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10300 NE HANCOCK ST, PORTLAND, OR 97220-3831
(503) 257-5500
Mailing address
10514 NW 26TH AVE, VANCOUVER, WA 98685-4817
(646) 732-5395
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA160964
OR
363AM0700X
Medical Physician Assistant
PA60112485
WA
363AS0400X
Surgical Physician Assistant
8968
NY
Other
Enumeration date
10/09/2007
Last updated
09/20/2023
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