Provider Demographics
NPI:1336858927
Name:PETRONI, ALYSSA ALLYSON
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ALLYSON
Last Name:PETRONI
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 1:546 W HARRY HERBERT DR
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1116
Mailing Address - Country:US
Mailing Address - Phone:563-210-8580
Mailing Address - Fax:
Practice Address - Street 1:1111 W KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5711
Practice Address - Country:US
Practice Address - Phone:563-468-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide