Provider Demographics
NPI:1972648715
Name:DIRIENZO, ALYSSA (ND)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DIRIENZO
Suffix:
Gender:F
Credentials:ND
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 2455
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-2455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 BALLARAT AVE N
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8191
Practice Address - Country:US
Practice Address - Phone:425-888-1018
Practice Address - Fax:425-888-0636
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT1173175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath