Provider Demographics
NPI:1851893721
Name:BAUMAN, ALYSSA MICHELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MICHELLE
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9042 W YUKON DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-6446
Mailing Address - Country:US
Mailing Address - Phone:620-474-1773
Mailing Address - Fax:
Practice Address - Street 1:20283 N LAKE PLEASANT RD STE 112
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:623-376-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ176025163W00000X
AZAP11455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse