Provider Demographics
NPI:1366954190
Name:DECHANT, ALYCE LYNN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:ALYCE
Middle Name:LYNN
Last Name:DECHANT
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1541 SUMMIT HILLS DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6534
Mailing Address - Country:US
Mailing Address - Phone:505-980-6360
Mailing Address - Fax:
Practice Address - Street 1:1101 -4 MEDICAL ARTS AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2273
Practice Address - Fax:505-925-6013
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NMPA2017-0086207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical