Provider Demographics
NPI:1447070461
Name:BIANCHI, ALYSSA RAE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RAE
Last Name:BIANCHI
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:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRE
Mailing Address - State:MA
Mailing Address - Zip Code:01074-0366
Mailing Address - Country:US
Mailing Address - Phone:978-870-7868
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 366
Practice Address - Street 2:
Practice Address - City:SOUTH BARRE
Practice Address - State:MA
Practice Address - Zip Code:01074-0366
Practice Address - Country:US
Practice Address - Phone:978-870-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN98461164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty