Provider Demographics
NPI: | 1023577616 |
---|---|
Name: | DENENBERG, ALYSSA (CPNP-PC) |
Entity Type: | Individual |
Prefix: | |
First Name: | ALYSSA |
Middle Name: | |
Last Name: | DENENBERG |
Suffix: | |
Gender: | F |
Credentials: | CPNP-PC |
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 191 |
Mailing Address - Street 2: | |
Mailing Address - City: | ROCKLAND |
Mailing Address - State: | DE |
Mailing Address - Zip Code: | 19732-0191 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 302-651-4200 |
Mailing Address - Fax: | 302-651-4945 |
Practice Address - Street 1: | NEMOURS DUPONT PEDIATRICS |
Practice Address - Street 2: | 1600 ROCKLAND ROAD |
Practice Address - City: | WILMINGTON |
Practice Address - State: | DE |
Practice Address - Zip Code: | 19803-3607 |
Practice Address - Country: | US |
Practice Address - Phone: | 302-651-4200 |
Practice Address - Fax: | 302-651-4945 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2019-03-14 |
Last Update Date: | 2020-10-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
DE | LJ-0010384 | 363L00000X |
PA | 020127 | 208000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
XXXXXXXXXX | Other | DO NOT HAVE ANY ADDITIONAL NUMBERS |