Provider Demographics
NPI:1144569401
Name:HANEKAMP, ALYSSA L (RN)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:L
Last Name:HANEKAMP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ALYSSA
Other - Middle Name:L
Other - Last Name:SZAMBELAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2433 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-5391
Mailing Address - Country:US
Mailing Address - Phone:608-289-8795
Mailing Address - Fax:
Practice Address - Street 1:2433 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-5391
Practice Address - Country:US
Practice Address - Phone:608-758-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI141539163WC0200X
WI141539-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine