Provider Demographics
NPI:1568954618
Name:KERR, ALYSSA MARIE
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:KERR
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 1:5036 COUNTY ROAD OK W
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-8976
Mailing Address - Country:US
Mailing Address - Phone:920-627-4619
Mailing Address - Fax:
Practice Address - Street 1:710 WOODVIEW AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085
Practice Address - Country:US
Practice Address - Phone:920-946-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI242044163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse