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General NPI Number Information
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NPI Number | 1174944755
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Entity Type | Individual
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Provider Name | ALYSSA MARLI ANDERSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/26/2013
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 38 SHERIDAN PARK CIR STE F
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City | BLUFFTON
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State | SC
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Zip | 29910-7023
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Country | US
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Telephone | 843-757-6744
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Fax |
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Provider Business Mailing Address
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Address Line | 135 PICKETT MILL BLVD
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City | OKATIE
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State | SC
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Zip | 29909-7831
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Country | US
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Telephone | 440-212-4047
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-04629
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2904
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License Number State | SC
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