Basic Information
| Provider Information | |||||||||
| NPI: | 1063178655 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATTAR | ||||||||
| FirstName: | MARISA | ||||||||
| MiddleName: | KELSEY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 NE DALLAS ST | ||||||||
| Address2: | |||||||||
| City: | CAMAS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986072058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608345055 | ||||||||
| FaxNumber: | 3608340504 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 NE DALLAS ST | ||||||||
| Address2: | |||||||||
| City: | CAMAS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986072058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608345055 | ||||||||
| FaxNumber: | 3608340504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2021 | ||||||||
| LastUpdateDate: | 11/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LP60600658 | WA | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.