Provider Demographics
NPI:1538642863
Name:HENNEBOEHLE, ALYSSA VANDERSLICE (NP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:VANDERSLICE
Last Name:HENNEBOEHLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:LAINE
Other - Last Name:VANDERSLICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12081 W ALAMEDA PKWY STE 438
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2701
Mailing Address - Country:US
Mailing Address - Phone:303-551-3643
Mailing Address - Fax:
Practice Address - Street 1:3345 FOREST ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-1944
Practice Address - Country:US
Practice Address - Phone:303-551-3643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0000928-C-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner