Doctor Name: | ALYSSA N WISLANDER |
NPI Number: | 1700166139 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 209008994 |
Business Practice Address: | 1604 Cleveland Rd Colona, IL - 612418970 |
Business Phone Number: | 3099492999 |
Business Fax Number: | 3099449199 |
Mailing Address: | 1970 Spruce Hills Dr, BETTENDORF |
State: | IA |
Postal Code: | 527222681 |
Phone Number: | 5633456788 |
Fax Number: | 5633456786 |
NPI Enumeration Date: | 08/17/2011 |
NPI Last Update Date: | 08/17/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209008994 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |