MEDICARE: ALYSSA MICHELLE HAGUE RN, BSN

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	163W00000X	Registered Nurse	RN306728	AZ

General Provider Information

NPI Number	:	1306670534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MICHELLE HAGUE RN, BSN

Provider Business Mailing Address
First Line	:	3807 E PUEBLO AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-1822
Country	:	US
Telephone Number	:	480-472-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3807 E PUEBLO AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-1822
Country	:	US
Telephone Number	:	480-472-6753
Fax Number	:

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

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	12/03/2024

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