Provider Demographics
NPI:1821432923
Name:SPONHAUER, ALYSSA M (FNP)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:M
Last Name:SPONHAUER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 WOODS CT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-2916
Mailing Address - Country:US
Mailing Address - Phone:541-386-2300
Mailing Address - Fax:541-436-4113
Practice Address - Street 1:1631 WOODS CT
Practice Address - Street 2:SUITE 103
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2916
Practice Address - Country:US
Practice Address - Phone:541-386-2300
Practice Address - Fax:541-436-4113
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201350073NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily