Provider Demographics
NPI:1790926400
Name:UNDERWOOD, ALISA JESSINE (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:JESSINE
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CEDAR LK W
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-1766
Mailing Address - Country:US
Mailing Address - Phone:973-534-8212
Mailing Address - Fax:
Practice Address - Street 1:45 CEDAR LK W
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-1766
Practice Address - Country:US
Practice Address - Phone:973-534-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11625500163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant