Provider Demographics
NPI:1295572592
Name:WELLER, ALYSSA (NP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:WELLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:SAN JOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12125 N LAZY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-7899
Mailing Address - Country:US
Mailing Address - Phone:520-909-9051
Mailing Address - Fax:
Practice Address - Street 1:6050 N CORONA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1096
Practice Address - Country:US
Practice Address - Phone:520-469-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN180416163W00000X
AZ2024054174363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse