Provider Demographics
NPI:1235845207
Name:KLISCH, ALYSSA ANNE (APN)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANNE
Last Name:KLISCH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BRONIA ST
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3805
Mailing Address - Country:US
Mailing Address - Phone:732-491-5470
Mailing Address - Fax:
Practice Address - Street 1:29 BRONIA ST
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3805
Practice Address - Country:US
Practice Address - Phone:732-491-5470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01425500363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care