Provider Demographics
NPI:1508515115
Name:HIPPLE, ALYSSA CHRISTINE (LAC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CHRISTINE
Last Name:HIPPLE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BRANDERMILL BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1604
Mailing Address - Country:US
Mailing Address - Phone:410-774-0800
Mailing Address - Fax:410-774-0799
Practice Address - Street 1:2401 BRANDERMILL BLVD STE 301
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1604
Practice Address - Country:US
Practice Address - Phone:410-774-0800
Practice Address - Fax:410-774-0799
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU02900OtherACUPUNCTURE LICENSE