Provider Demographics
NPI:1679061311
Name:EGAN, ALYSSA M
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:M
Last Name:EGAN
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 1:1115 W ROWAN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-4641
Mailing Address - Country:US
Mailing Address - Phone:307-272-1137
Mailing Address - Fax:
Practice Address - Street 1:C-8247 ARDENNES STREET
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-1035
Practice Address - Country:US
Practice Address - Phone:910-807-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program