Healthcare Provider Details

I. General information

NPI: 1780541771
Provider Name (Legal Business Name): ALYSSA HEMMEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 N 16TH ST STE 102
PHOENIX AZ
85020-5266
US

IV. Provider business mailing address

11230 ELEMIS DR
DAPHNE AL
36526-7293
US

V. Phone/Fax

Practice location:
  • Phone: 480-420-4027
  • Fax:
Mailing address:
  • Phone: 316-621-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-150045-011
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: