MEDICARE: ALISSA ROSE SPEARS MS, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1184138729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISSA ROSE SPEARS MS, MBA

Provider Business Mailing Address
First Line	:	3531 FOX CHASE DR
Second Line	:
City	:	IMPERIAL
State	:	PA
Zip	:	15126-9604
Country	:	US
Telephone Number	:	724-971-9679
Fax Number	:

Provider Business Practice Location Address
First Line	:	3531 FOX CHASE DR
Second Line	:
City	:	IMPERIAL
State	:	PA
Zip	:	15126-9604
Country	:	US
Telephone Number	:	724-971-9679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2017
Last Update Date	:	11/17/2017

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