Provider Demographics
NPI:1427486596
Name:VADASZ, ALISA
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:VADASZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 N EDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-8711
Mailing Address - Country:US
Mailing Address - Phone:928-522-0543
Mailing Address - Fax:
Practice Address - Street 1:2187 N VICKEY ST STE 2
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-6121
Practice Address - Country:US
Practice Address - Phone:928-714-5322
Practice Address - Fax:928-526-9503
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5077363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care