Provider Demographics
NPI:1639405251
Name:FUEHRER, ALYSSA DYAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:DYAN
Last Name:FUEHRER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ALYSSA
Other - Middle Name:DYAN
Other - Last Name:HAWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:24520 GRAND CENTRAL PKWY
Mailing Address - Street 2:APARTMENT LH
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-2741
Mailing Address - Country:US
Mailing Address - Phone:206-412-7217
Mailing Address - Fax:
Practice Address - Street 1:915 ANDERSON DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1006
Practice Address - Country:US
Practice Address - Phone:360-537-4130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA 60118221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant