Healthcare Provider Details

I. General information

NPI: 1124252648
Provider Name (Legal Business Name): ALISSA A ALBERTS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISSA A BULT CRNA

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S CLIFF AVE ANESTHESIA DEPT
SIOUX FALLS SD
57105-1007
US

IV. Provider business mailing address

PO BOX 5045 ATTN: PFS, PROV ENRLLMT
SIOUX FALLS SD
57117-5045
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-2796
  • Fax:
Mailing address:
  • Phone: 605-322-2796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberSD-CRNA CR000720
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: