Provider Demographics
NPI:1912552027
Name:CZUDEK, ALYSSA (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:CZUDEK
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 BASS RD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-6545
Mailing Address - Country:US
Mailing Address - Phone:337-353-2282
Mailing Address - Fax:
Practice Address - Street 1:108 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3521
Practice Address - Country:US
Practice Address - Phone:318-704-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2019044689363LP0808X
LA2083141363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health