Provider Demographics
NPI:1598283079
Name:DECONTO, ALYSSA (CNM, WHNP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DECONTO
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6583
Mailing Address - Country:US
Mailing Address - Phone:022-964-0278
Mailing Address - Fax:855-794-0985
Practice Address - Street 1:1329 MISSION RD
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6583
Practice Address - Country:US
Practice Address - Phone:202-964-0278
Practice Address - Fax:855-794-0985
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125740363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health