Healthcare Provider Details

I. General information

NPI: 1609787837
Provider Name (Legal Business Name): ALYSSA BLUEMEL PPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 GAGE AVE
EVANSTON WY
82930-5151
US

IV. Provider business mailing address

609 GAGE AVE
EVANSTON WY
82930-5151
US

V. Phone/Fax

Practice location:
  • Phone: 307-254-1818
  • Fax: 307-481-7321
Mailing address:
  • Phone: 307-254-1818
  • Fax: 307-481-7321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1707
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: