Provider Demographics
NPI:1033736970
Name:FRIEDMAN, ALYSSA NATALE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:NATALE
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 JACKSONIA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-1224
Mailing Address - Country:US
Mailing Address - Phone:401-573-1136
Mailing Address - Fax:
Practice Address - Street 1:115 JACKSONIA DR
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-1224
Practice Address - Country:US
Practice Address - Phone:401-573-1136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4980363A00000X
363A00000X
MAPA7717363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant