Provider Demographics
NPI:1255417895
Name:SHATTENBERG, ALISSA (FNP)
Entity type:Individual
Prefix:MS
First Name:ALISSA
Middle Name:
Last Name:SHATTENBERG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 W GUTIERREZ ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3835
Mailing Address - Country:US
Mailing Address - Phone:805-968-1511
Mailing Address - Fax:805-685-2467
Practice Address - Street 1:970 EMBARCADERO DEL MAR
Practice Address - Street 2:
Practice Address - City:ISLA VISTA
Practice Address - State:CA
Practice Address - Zip Code:93117-4869
Practice Address - Country:US
Practice Address - Phone:805-968-1511
Practice Address - Fax:805-685-2467
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 15692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP15692OtherNURSE PRACTITIONER LICENS