Provider Demographics
NPI:1497356810
Name:COLLINS, ALYSSA
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:COLLINS
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 1:11 PORTER LN
Mailing Address - Street 2:
Mailing Address - City:WEST DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02670-2318
Mailing Address - Country:US
Mailing Address - Phone:802-779-1546
Mailing Address - Fax:
Practice Address - Street 1:11 PORTER LN
Practice Address - Street 2:
Practice Address - City:WEST DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02670-2318
Practice Address - Country:US
Practice Address - Phone:802-779-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MARN2329125363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program