Provider Demographics
NPI:1265473870
Name:BISCH, ALISA WATERS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:WATERS
Last Name:BISCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 WASHINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-2156
Mailing Address - Country:US
Mailing Address - Phone:865-637-4970
Mailing Address - Fax:865-637-5036
Practice Address - Street 1:4824 WASHINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-2156
Practice Address - Country:US
Practice Address - Phone:865-637-4970
Practice Address - Fax:865-637-5036
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11390363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ50330Medicare UPIN