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General NPI Number Information
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NPI Number | 1689465031
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Entity Type | Individual
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Provider Name | ALYSSA MCDONOUGH ACNPC-AG
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Gender | Female
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 15 STRAWBERRY AVE
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City | LEWISTON
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State | ME
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Zip | 04240-5941
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Country | US
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Telephone | 207-777-7744
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Fax |
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Provider Business Mailing Address
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Address Line | 10 CONTANT DR
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City | GRAY
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State | ME
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Zip | 04039-7540
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Country | US
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Telephone |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | CNP251189
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License Number State | ME
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