Healthcare Provider Details

I. General information

NPI: 1881781656
Provider Name (Legal Business Name): ALYSSA PAYER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA DECOTEAU NP

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HOSPITAL LOOP 1300 HOSPITAL LOOP
BELCOURT ND
58316-0160
US

IV. Provider business mailing address

40520 COUNTY HIGHWAY 34
OGEMA MN
56569-9612
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-6111
  • Fax: 701-477-2539
Mailing address:
  • Phone: 218-983-4300
  • Fax: 218-983-6395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR27228
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: