Healthcare Provider Details

I. General information

NPI: 1326857574
Provider Name (Legal Business Name): ALYSSA HAMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4535 NORTHERN SKY DR
BISMARCK ND
58503-8538
US

IV. Provider business mailing address

4535 NORTHERN SKY DR
BISMARCK ND
58503-8538
US

V. Phone/Fax

Practice location:
  • Phone: 218-686-7574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number32308022
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: