Healthcare Provider Details

I. General information

NPI: 1831761808
Provider Name (Legal Business Name): ALYSSA JANE JELSEMA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA JANE ORAM CRNA

II. Dates (important events)

Enumeration Date: 07/10/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E SHERMAN BLVD
MUSKEGON MI
49444-1849
US

IV. Provider business mailing address

3504 CHICAGO DR APT B
HUDSONVILLE MI
49426-1456
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704307707
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: