Healthcare Provider Details

I. General information

NPI: 1023996972
Provider Name (Legal Business Name): ALYSE CHRISTINE HAGGERTY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 PEACH ST
ERIE PA
16509-2603
US

IV. Provider business mailing address

3413 HAMPSHIRE RD
ERIE PA
16506-3319
US

V. Phone/Fax

Practice location:
  • Phone: 814-864-4031
  • Fax:
Mailing address:
  • Phone: 814-823-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN709228
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: