Provider Demographics
NPI:1821510173
Name:DEHUT, ALYSSA HELEN (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:HELEN
Last Name:DEHUT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:HELEN
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:875 OAK ST SE STE 4030
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3984
Mailing Address - Country:US
Mailing Address - Phone:503-561-6444
Mailing Address - Fax:
Practice Address - Street 1:875 OAK ST SE STE 4030
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3984
Practice Address - Country:US
Practice Address - Phone:503-561-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54621363A00000X
ORPA195071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant