Healthcare Provider Details

I. General information

NPI: 1548769094
Provider Name (Legal Business Name): MS. ALYSSA M ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD STE 203
WARWICK RI
02886-1687
US

IV. Provider business mailing address

74 RIVERVIEW DR
CHARLESTOWN RI
02813-4003
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-1320
  • Fax: 401-737-2120
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number460
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: