Healthcare Provider Details

I. General information

NPI: 1720095045
Provider Name (Legal Business Name): ALYSSA HANNAH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N 3RD ST
REYNOLDSVILLE PA
15851-0907
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-653-8222
  • Fax: 814-353-9305
Mailing address:
  • Phone: 814-375-3750
  • Fax: 814-375-9624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA-051623
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: