Provider Demographics
NPI:1871099945
Name:POULIN, ALYSA ANNE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ALYSA
Middle Name:ANNE
Last Name:POULIN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 SANDPOINT WAY NE
Mailing Address - Street 2:OC.8.722
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-987-2577
Mailing Address - Fax:206-987-3840
Practice Address - Street 1:850 REPUBLICAN ST
Practice Address - Street 2:C-432
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4325
Practice Address - Country:US
Practice Address - Phone:204-396-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program