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General NPI Number Information
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NPI Number | 1861700627
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Entity Type | Individual
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Provider Name | ALANA ANISE VAN PUTTEN-LAGUERRE NMD, PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 5638 HIGHWAY 53 UNIT B195
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City | HARVEST
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State | AL
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Zip | 35749-8555
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Country | US
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Telephone | 256-346-8185
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Fax |
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Provider Business Mailing Address
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Address Line | 852 COUNTY ROAD 250
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City | SCOTTSBORO
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State | AL
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Zip | 35768-5034
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Country | US
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Telephone | 301-655-5989
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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 | C0004153
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License Number State | MD
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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 | 8387
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 0990134041
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License Number State | VT
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