Provider Demographics
NPI:1578749743
Name:NORDELL, ALYSSA
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:NORDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:SKLIRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7721 S HUGHES AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6201
Mailing Address - Country:US
Mailing Address - Phone:605-271-5530
Mailing Address - Fax:
Practice Address - Street 1:1316 MCMILLAN ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1646
Practice Address - Country:US
Practice Address - Phone:507-376-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH6938124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist