Provider Demographics
NPI:1073849758
Name:PIPER, ALYSE Y (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSE
Middle Name:Y
Last Name:PIPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSE
Other - Middle Name:K
Other - Last Name:YANUSKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1950 GLENN MITCHELL DR
Mailing Address - Street 2:STE 300
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0019
Mailing Address - Country:US
Mailing Address - Phone:757-507-0305
Mailing Address - Fax:757-507-0218
Practice Address - Street 1:1950 GLENN MITCHELL DR
Practice Address - Street 2:STE 300
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0019
Practice Address - Country:US
Practice Address - Phone:757-507-0305
Practice Address - Fax:757-507-0218
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003164363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical