Provider Demographics
NPI:1992548499
Name:HALL, ALYSSA (AGNP-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOWMAN
Mailing Address - State:NY
Mailing Address - Zip Code:14861-8722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 GUTHRIE DR
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-3696
Practice Address - Country:US
Practice Address - Phone:607-973-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN732095163W00000X
NY312004363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse