Provider Demographics
NPI:1104169663
Name:HEALY, ALYSN D (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSN
Middle Name:D
Last Name:HEALY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSN
Other - Middle Name:D
Other - Last Name:LUDWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:43 WHITING HILL RD
Mailing Address - Street 2:STE 300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-973-5035
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:417 STATE ST STE 421
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6639
Practice Address - Country:US
Practice Address - Phone:207-973-4633
Practice Address - Fax:207-973-5263
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1386363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME225421735400607Medicaid