Basic Information
| Provider Information | |||||||||
| NPI: | 1508484395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOULEK | ||||||||
| FirstName: | ALIA | ||||||||
| MiddleName: | EMILIE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ALSHARE-SOULEK | ||||||||
| OtherFirstName: | ALIA | ||||||||
| OtherMiddleName: | EMILIE | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 16414 S DOVER RD | ||||||||
| Address2: | |||||||||
| City: | CHENEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990049602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098220211 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 122 W 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094743278 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2020 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 61084974 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.