Provider Demographics
NPI:1285661744
Name:LOPEZ-CASTOR, ALESSA L (FNP-C)
Entity type:Individual
Prefix:
First Name:ALESSA
Middle Name:L
Last Name:LOPEZ-CASTOR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 31ST AVE NE STE 101
Mailing Address - Street 2:
Mailing Address - City:TULALIP
Mailing Address - State:WA
Mailing Address - Zip Code:98271-7423
Mailing Address - Country:US
Mailing Address - Phone:360-716-2200
Mailing Address - Fax:360-716-2211
Practice Address - Street 1:6330 31ST AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-7423
Practice Address - Country:US
Practice Address - Phone:360-716-2200
Practice Address - Fax:360-716-2211
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60420859363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDNPWF1OtherBLUE CROSS
ID80693310Medicaid
ID000010152176OtherBLUE SHIELD
WA2035703Medicaid
ID80693310Medicaid
IDNPWF1OtherBLUE CROSS
ID000010152176OtherBLUE SHIELD