Healthcare Provider Details

I. General information

NPI: 1093690299
Provider Name (Legal Business Name): ALYSSA MARIE NAROG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2711
US

IV. Provider business mailing address

1565 GARFIELD PARK BLVD
LEBANON OH
45036-9282
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-3356
  • Fax:
Mailing address:
  • Phone: 937-701-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: