Provider Demographics
NPI:1457592172
Name:STAGGERT, ALYSSA (LPN)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:
Last Name:STAGGERT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 GALLUP RD
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-9558
Mailing Address - Country:US
Mailing Address - Phone:585-202-1048
Mailing Address - Fax:
Practice Address - Street 1:245 GALLUP RD
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-9558
Practice Address - Country:US
Practice Address - Phone:585-202-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296394164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse