Provider Demographics
NPI:1942067947
Name:WEGENER, ALYSSA ANN-RACHEL (APRN-NP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANN-RACHEL
Last Name:WEGENER
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:ANN-RACHEL
Other - Last Name:MALECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6149
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-0149
Mailing Address - Country:US
Mailing Address - Phone:971-281-3000
Mailing Address - Fax:
Practice Address - Street 1:2251 E HANCOCK ST STE 103
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2145
Practice Address - Country:US
Practice Address - Phone:971-281-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10021767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily