Provider Demographics
NPI:1679308076
Name:EICH, ALYSSA KATHRYN (CNP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KATHRYN
Last Name:EICH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:KATHRYN
Other - Last Name:VOLMER-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:833 RIVER TER
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54021-7043
Mailing Address - Country:US
Mailing Address - Phone:651-269-7577
Mailing Address - Fax:
Practice Address - Street 1:833 RIVER TER
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:WI
Practice Address - Zip Code:54021-7043
Practice Address - Country:US
Practice Address - Phone:651-269-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11361363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics