Provider Demographics
NPI:1710426879
Name:GUNAWAN, ALYSSA DANIELLE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:DANIELLE
Last Name:GUNAWAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:ALYSSA
Other - Middle Name:DANIELLE
Other - Last Name:SALAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3413 ALEXANDER CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1268
Mailing Address - Country:US
Mailing Address - Phone:480-694-1260
Mailing Address - Fax:
Practice Address - Street 1:3369 BUFORD HWY NE
Practice Address - Street 2:SUITE NUMBER 810
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-3722
Practice Address - Country:US
Practice Address - Phone:404-321-4692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN264580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily