Provider Demographics
NPI:1740909167
Name:DESANTIS, ALISSA KATHLEEN (MSN, RN)
Entity type:Individual
Prefix:MS
First Name:ALISSA
Middle Name:KATHLEEN
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SCHOOL ST APT 6
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2819
Mailing Address - Country:US
Mailing Address - Phone:508-631-0945
Mailing Address - Fax:
Practice Address - Street 1:35 GATEHOUSE DR # D00.09
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1215
Practice Address - Country:US
Practice Address - Phone:508-631-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2284658163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse