Provider Demographics
NPI:1407282320
Name:WRIGHT, ALYSSA VAHALA (PA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:VAHALA
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:DANIELLE
Other - Last Name:VAHALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3827 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3339
Mailing Address - Country:US
Mailing Address - Phone:303-500-1518
Mailing Address - Fax:720-598-0440
Practice Address - Street 1:8060 SW PFAFFLE ST STE 102
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8489
Practice Address - Country:US
Practice Address - Phone:503-714-8987
Practice Address - Fax:720-598-0440
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04521363A00000X
ORPA202447363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant