Provider Demographics
NPI:1063131431
Name:FOOCE, ALYSSA R
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:R
Last Name:FOOCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 GOSHORN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1447
Mailing Address - Country:US
Mailing Address - Phone:304-542-5755
Mailing Address - Fax:
Practice Address - Street 1:524 GOSHORN ST APT 1
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1447
Practice Address - Country:US
Practice Address - Phone:304-542-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant