Provider Demographics
NPI:1376084426
Name:ELLISON, ALYSSA M
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:M
Last Name:ELLISON
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 1:1222 E DENWALL DR
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3155
Mailing Address - Country:US
Mailing Address - Phone:310-213-2205
Mailing Address - Fax:
Practice Address - Street 1:1222 E DENWALL DR
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3155
Practice Address - Country:US
Practice Address - Phone:310-213-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula