Healthcare Provider Details

I. General information

NPI: 1902700883
Provider Name (Legal Business Name): ALYSSA TJADER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 W HAWAII AVE
NAMPA ID
83686-8176
US

IV. Provider business mailing address

1211 W HAWAII AVE
NAMPA ID
83686-8176
US

V. Phone/Fax

Practice location:
  • Phone: 319-930-9875
  • Fax:
Mailing address:
  • Phone: 319-930-9875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: