Provider Demographics
NPI:1952596827
Name:SEEBERGER, ALISA A (APRN)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:A
Last Name:SEEBERGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:1401 10TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5012
Mailing Address - Country:US
Mailing Address - Phone:575-437-4533
Mailing Address - Fax:801-437-5009
Practice Address - Street 1:1401 10TH ST STE C
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5012
Practice Address - Country:US
Practice Address - Phone:575-437-4533
Practice Address - Fax:575-437-5009
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT194734-4405-8900363LF0000X
NM64999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1679242457Medicaid