Provider Demographics
NPI:1669811931
Name:PIERCE, ALYSSA KATE ELAINE (HHA)
Entity type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:KATE ELAINE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 SCHELE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46803-2775
Mailing Address - Country:US
Mailing Address - Phone:260-267-1821
Mailing Address - Fax:
Practice Address - Street 1:3044 SCHELE AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46803
Practice Address - Country:US
Practice Address - Phone:260-267-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INHHA1302279163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN105549125099Medicaid