Provider Demographics
NPI:1922858166
Name:ADAM, ALYSSA JUSTINE (CRNP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JUSTINE
Last Name:ADAM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:JUSTINE
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:843 WESTBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-8837
Mailing Address - Country:US
Mailing Address - Phone:570-573-9270
Mailing Address - Fax:
Practice Address - Street 1:2221 NOLL DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-7614
Practice Address - Country:US
Practice Address - Phone:717-715-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily