Provider Demographics
NPI:1366641391
Name:DZIONDZIAK, ALYSSA CORYNE (RN, CWON)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:CORYNE
Last Name:DZIONDZIAK
Suffix:
Gender:F
Credentials:RN, CWON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W243N2331 SADDLE BROOK DR APT 2
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-6420
Mailing Address - Country:US
Mailing Address - Phone:414-530-8760
Mailing Address - Fax:
Practice Address - Street 1:W243N2331 SADDLE BROOK DR APT 2
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-6420
Practice Address - Country:US
Practice Address - Phone:414-530-8760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI186756163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care