Provider Demographics
NPI:1306669213
Name:MANNESS, ALEXANDRA NOELLE (BSN, RN)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:NOELLE
Last Name:MANNESS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 DAVIE STREET
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V8S 4E3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1412 SW 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4803
Practice Address - Country:US
Practice Address - Phone:142-526-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61442486163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health