MEDICARE: ALYSE DANAE MCNAIR B.S.

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	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1861739351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSE DANAE MCNAIR B.S.

Provider Business Mailing Address
First Line	:	711 N EVERGREEN RD APT 3002
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-7556
Country	:	US
Telephone Number	:	909-518-1143
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 N EVERGREEN RD APT 3002
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-7556
Country	:	US
Telephone Number	:	909-518-1143
Fax Number	:

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

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	01/03/2013

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