Healthcare Provider Details

I. General information

NPI: 1881316537
Provider Name (Legal Business Name): ALYSSA ANN WOJCIECHOWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 HARDING PIKE STE 500
NASHVILLE TN
37205-2005
US

IV. Provider business mailing address

48815 HUNTER DR
MACOMB MI
48044-5569
US

V. Phone/Fax

Practice location:
  • Phone: 615-222-2111
  • Fax:
Mailing address:
  • Phone: 586-292-9960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5277
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: