Provider Demographics
NPI:1801665971
Name:GONCALVES, ALYSSA (CNP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:GONCALVES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 OLIVEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4410
Mailing Address - Country:US
Mailing Address - Phone:419-575-0502
Mailing Address - Fax:
Practice Address - Street 1:2429 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1024
Practice Address - Country:US
Practice Address - Phone:216-368-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0035586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner