Provider Demographics
NPI:1306488564
Name:MORAIS, ALYSON RAE (FNP)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:RAE
Last Name:MORAIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:RAE
Other - Last Name:GWOZDZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:600 OLD SOMERSET AVE, PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:NORTH DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02764
Mailing Address - Country:US
Mailing Address - Phone:508-824-7557
Mailing Address - Fax:508-824-8296
Practice Address - Street 1:600 OLD SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:NORTH DIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02764
Practice Address - Country:US
Practice Address - Phone:508-824-7557
Practice Address - Fax:508-824-8296
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2289179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110158427AMedicaid