Provider Demographics
NPI:1891060760
Name:ROBINSON, ALYSSA D (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:D
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 N. GREEN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2417
Mailing Address - Country:US
Mailing Address - Phone:317-852-3851
Mailing Address - Fax:317-852-1246
Practice Address - Street 1:1080 N. GREEN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2417
Practice Address - Country:US
Practice Address - Phone:317-852-3851
Practice Address - Fax:317-852-1246
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003889A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201057820Medicaid
INM400066767Medicare PIN