Basic Information
| Provider Information | |||||||||
| NPI: | 1922572718 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEBB | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3240 JUHL RD | ||||||||
| Address2: | |||||||||
| City: | MARLETTE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484538992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8108589201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1363 DOUGLAS DR STE 104 | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496968980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316684909 | ||||||||
| FaxNumber: | 2319431334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2019 | ||||||||
| LastUpdateDate: | 01/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | MI | Y |
No ID Information.