Provider Demographics
NPI:1437461837
Name:WAMPOLE, ALYSSA J (OMD, LAC)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:J
Last Name:WAMPOLE
Suffix:
Gender:F
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 E FLAMINGO RD # 535
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5263
Mailing Address - Country:US
Mailing Address - Phone:702-858-2125
Mailing Address - Fax:
Practice Address - Street 1:4700 S MARYLAND PKWY STE 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6318
Practice Address - Country:US
Practice Address - Phone:702-858-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1029171100000X
CAAC 10367171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist