Healthcare Provider Details

I. General information

NPI: 1629906193
Provider Name (Legal Business Name): ALISSA ANNE BOYER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 11TH AVE APT 4403
NEW YORK NY
10001-1769
US

IV. Provider business mailing address

1178 BROADWAY FL 3
NEW YORK NY
10001-5666
US

V. Phone/Fax

Practice location:
  • Phone: 518-703-6840
  • Fax: 518-613-1350
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026036308
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: