Provider Demographics
NPI:1649973538
Name:JAWORSKI, ALYSSA (FNP-BC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:JAWORSKI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50505 SCHOENHERR RD STE 340
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3140
Mailing Address - Country:US
Mailing Address - Phone:586-731-8400
Mailing Address - Fax:586-731-8406
Practice Address - Street 1:50505 SCHOENHERR RD STE 340
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3140
Practice Address - Country:US
Practice Address - Phone:586-731-8400
Practice Address - Fax:586-731-8406
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704354057163WW0000X, 363LF0000X
MI4704354057NSA2307T363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound Care