Provider Demographics
NPI:1922615822
Name:ARLEN, ALYSSA JANE (RN)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:JANE
Last Name:ARLEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 79
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12838-0079
Mailing Address - Country:US
Mailing Address - Phone:518-632-5222
Mailing Address - Fax:518-632-5231
Practice Address - Street 1:4704 STATE ROUTE 149
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:12838
Practice Address - Country:US
Practice Address - Phone:518-632-5222
Practice Address - Fax:518-632-5231
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY552713163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool