Healthcare Provider Details

I. General information

NPI: 1770309015
Provider Name (Legal Business Name): ALYSSE WAID NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12061 SHERATON LN
CINCINNATI OH
45246-1611
US

IV. Provider business mailing address

479 PLEASANT RIDGE DR
LEBANON OH
45036-3551
US

V. Phone/Fax

Practice location:
  • Phone: 270-577-5023
  • Fax:
Mailing address:
  • Phone: 270-577-5023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0038221
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: