Provider Demographics
NPI:1316785595
Name:DE LUNA, ALYSSA PATRICIA MANESE (BSN, RN)
Entity type:Individual
Prefix:
First Name:ALYSSA PATRICIA
Middle Name:MANESE
Last Name:DE LUNA
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9621 DRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4623
Mailing Address - Country:US
Mailing Address - Phone:714-616-9173
Mailing Address - Fax:
Practice Address - Street 1:5155 S DURANGO DR STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0174
Practice Address - Country:US
Practice Address - Phone:702-869-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV874596163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse