Provider Demographics
NPI:1619687506
Name:DEVANTIER, ALYSSA (RN)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DEVANTIER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 4TH STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446
Mailing Address - Country:US
Mailing Address - Phone:805-234-6789
Mailing Address - Fax:
Practice Address - Street 1:805 4TH STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446
Practice Address - Country:US
Practice Address - Phone:805-237-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95103377163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health