Provider Demographics
NPI:1275369332
Name:LANNOO, ALYSSA P (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:P
Last Name:LANNOO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:R
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 W 16TH ST STE 3200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2280
Mailing Address - Country:US
Mailing Address - Phone:317-948-5450
Mailing Address - Fax:317-963-7079
Practice Address - Street 1:355 W 16TH ST STE 3200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2280
Practice Address - Country:US
Practice Address - Phone:317-948-5450
Practice Address - Fax:317-963-7079
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10004529A363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical