Provider Demographics
NPI:1043729445
Name:MIERTA, ALYSSA (CLC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MIERTA
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 ELM DR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3625
Mailing Address - Country:US
Mailing Address - Phone:1609-558-5586
Mailing Address - Fax:
Practice Address - Street 1:3129 ELM DR
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3625
Practice Address - Country:US
Practice Address - Phone:1609-558-5586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAALPP227787174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN