Provider Demographics
NPI:1275280166
Name:FEDEL, ALYSSA JANAE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:JANAE
Last Name:FEDEL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:JANAE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:POB 403
Mailing Address - Street 2:
Mailing Address - City:OURAY
Mailing Address - State:CO
Mailing Address - Zip Code:81427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:947 SOUTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401
Practice Address - Country:US
Practice Address - Phone:970-249-2421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORXN.0106436-NP363LF0000X
CORN.1667276163W00000X
COAPN.0997358-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse