Provider Demographics
NPI:1326422809
Name:SCHWASS, ALISA
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:SCHWASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 SUTHERLAND DR
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-5069
Mailing Address - Country:US
Mailing Address - Phone:251-753-3512
Mailing Address - Fax:
Practice Address - Street 1:2743 SUTHERLAND DR
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-5069
Practice Address - Country:US
Practice Address - Phone:251-753-3512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN82341164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse