MEDICARE: ALYSSA DIRIENZO N.D.

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	175F00000X	Naturopath	NT1173	WA

General Provider Information

NPI Number	:	1972648715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA DIRIENZO N.D.

Provider Business Mailing Address
First Line	:	PO BOX 2455
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-2455
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 BALLARAT AVE N
Second Line	:	SUITE 201
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8191
Country	:	US
Telephone Number	:	425-888-1018
Fax Number	:	425-888-0636

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	10/20/2015

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