Provider Demographics
NPI:1932310216
Name:HUNTSINGER, ALYCE M (FNP, NNP)
Entity Type:Individual
Prefix:
First Name:ALYCE
Middle Name:M
Last Name:HUNTSINGER
Suffix:
Gender:F
Credentials:FNP, NNP
Other - Prefix:
Other - First Name:ALYCE
Other - Middle Name:M
Other - Last Name:HUNTSINGER-MICKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP
Mailing Address - Street 1:2480 LIBERTY STREET NE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-363-8047
Mailing Address - Fax:503-363-6571
Practice Address - Street 1:2480 LIBERTY ST NE
Practice Address - Street 2:SUITE 180
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-8380
Practice Address - Country:US
Practice Address - Phone:503-363-8047
Practice Address - Fax:503-363-6571
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200850051NP363LF0000X
OR081047091N9363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9644345Medicaid
OR022927Medicaid