Provider Demographics
NPI:1679300214
Name:SWEET, ALYSSA GAYLE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:GAYLE
Last Name:SWEET
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 1:471 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-2007
Mailing Address - Country:US
Mailing Address - Phone:413-733-1431
Mailing Address - Fax:413-732-1635
Practice Address - Street 1:471 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-2007
Practice Address - Country:US
Practice Address - Phone:413-733-1431
Practice Address - Fax:413-732-1635
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2365204163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse