Provider Demographics
NPI:1003537325
Name:SONNENTAG, ALYSA (APRN)
Entity Type:Individual
Prefix:
First Name:ALYSA
Middle Name:
Last Name:SONNENTAG
Suffix:
Gender:F
Credentials:APRN
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 877116
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-7116
Mailing Address - Country:US
Mailing Address - Phone:307-371-5708
Mailing Address - Fax:
Practice Address - Street 1:211 E FAIRVIEW LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-0568
Practice Address - Country:US
Practice Address - Phone:907-373-3335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK198025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily