Provider Demographics
NPI:1790233930
Name:BASSLER, ALICYN (CRNP)
Entity Type:Individual
Prefix:
First Name:ALICYN
Middle Name:
Last Name:BASSLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 IVY LEAGUE DR
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1655 CROFTON BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1379
Practice Address - Country:US
Practice Address - Phone:410-263-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194243363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics