Provider Demographics
NPI:1790213932
Name:GRISSOM, ALYSSA (APN, AGCNS)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:GRISSOM
Suffix:
Gender:F
Credentials:APN, AGCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 10TH ST SE STE 285
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2437
Mailing Address - Country:US
Mailing Address - Phone:319-369-7816
Mailing Address - Fax:
Practice Address - Street 1:202 10TH ST SE STE 285
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2437
Practice Address - Country:US
Practice Address - Phone:319-369-7816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014163364SA2200X
IAW178806364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health