Provider Demographics
NPI:1376941195
Name:NAKONECZNY, ALYSHA ZOE (FNP)
Entity Type:Individual
Prefix:
First Name:ALYSHA
Middle Name:ZOE
Last Name:NAKONECZNY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 RAWLINGS CT
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-1812
Mailing Address - Country:US
Mailing Address - Phone:314-541-2247
Mailing Address - Fax:
Practice Address - Street 1:32 W WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-4224
Practice Address - Country:US
Practice Address - Phone:804-431-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily