Provider Demographics
NPI:1336515659
Name:HOWARD, ALISSA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:ALISSA
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:11 UNION ST S STE 314
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-5059
Mailing Address - Country:US
Mailing Address - Phone:704-281-9928
Mailing Address - Fax:
Practice Address - Street 1:2112 HIGHLAND KNOLL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3574
Practice Address - Country:US
Practice Address - Phone:704-281-9928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC291687163W00000X
NY667572163WH0200X, 163W00000X, 163WP0807X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health