Healthcare Provider Details

I. General information

NPI: 1477924942
Provider Name (Legal Business Name): ALISSA VIGIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 14010 BLDG. 26012
APO AP
96543-4003
US

IV. Provider business mailing address

UNIT 14010 BLDG. 26012 ANDERSEN AFP
APO AP
96543-4003
US

V. Phone/Fax

Practice location:
  • Phone: 671-366-3326
  • Fax:
Mailing address:
  • Phone: 671-366-3326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN2291799
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: