Provider Demographics
NPI:1154807410
Name:DENNIE, ALYSSA ANN (FNP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANN
Last Name:DENNIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37399 GARFIELD RD STE 203
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3672
Mailing Address - Country:US
Mailing Address - Phone:586-228-2911
Mailing Address - Fax:586-228-2901
Practice Address - Street 1:37399 GARFIELD RD STE 203
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-3672
Practice Address - Country:US
Practice Address - Phone:586-228-2911
Practice Address - Fax:586-228-2901
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704284743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily