Provider Demographics
NPI:1265588198
Name:GUNDERSON, ALYSSA DAWN
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:DAWN
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 ELK ST
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4520
Mailing Address - Country:US
Mailing Address - Phone:307-362-2213
Mailing Address - Fax:307-362-2213
Practice Address - Street 1:1212 ELK ST
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4520
Practice Address - Country:US
Practice Address - Phone:307-362-2213
Practice Address - Fax:307-362-2213
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15089376K00000X
WY373H00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered376K00000XNursing Service Related ProvidersNurse's Aide
Not Answered373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Not Answered376J00000XNursing Service Related ProvidersHomemaker