Provider Demographics
NPI:1427646306
Name:REISTER, ALYSSA (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:REISTER
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 LOS COLONIS DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-6402
Mailing Address - Country:US
Mailing Address - Phone:502-424-8978
Mailing Address - Fax:
Practice Address - Street 1:913 LOS COLONIS DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-6402
Practice Address - Country:US
Practice Address - Phone:502-424-8978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015464363LF0000X
VA0024180652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily