Provider Demographics
NPI:1154954279
Name:ATHMAN, ALYSSA DAWN (RDN)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:DAWN
Last Name:ATHMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20323 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-6509
Mailing Address - Country:US
Mailing Address - Phone:320-630-8108
Mailing Address - Fax:
Practice Address - Street 1:20323 HICKORY RD
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-6509
Practice Address - Country:US
Practice Address - Phone:320-630-8108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered