| NPI | 1669024709 |
|---|---|
| Former Name | ALYSSA FAIRBANKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WV 103907) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WV 103907) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WV 103907) | |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2021-10-19 |