| NPI | 1912214958 |
|---|---|
| Former Name | ALYSSA BRIANNE VANDER HEYDEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AR PA-734) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 1689) |
| 363A00000X Physician Assistant (Licence: IN 10001210) | |
| 363AS0400X Physician Assistant, Surgical (Licence: PA MA07081) | |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2023-05-25 |