Provider Demographics
NPI:1861431132
Name:WASHINGTON, ARLISSA MARIE (CRNA)
Entity type:Individual
Prefix:
First Name:ARLISSA
Middle Name:MARIE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:115 NEW VIEW CT NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5250
Practice Address - Country:US
Practice Address - Phone:360-252-1642
Practice Address - Fax:360-252-1646
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK110657367500000X
NMR48282367500000X
MTNUR-RN-LIC-103625367500000X
ID51837367500000X
OR20160320RN367500000X
MI4704246294367500000X
WAAP30006518367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1831431132Medicaid
ID1861431132Medicaid
WA2010148Medicaid
OR500705934Medicaid
NM481484YWN7OtherMEDICARE NM
NM02103869Medicaid
WAG8950928OtherMEDICARE WA