Provider Demographics
NPI:1548815459
Name:LISSE, DANIELLE (DNP,APRN,CPNP-PC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:LISSE
Suffix:
Gender:F
Credentials:DNP,APRN,CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 DEBARR RD STE C308
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2972
Mailing Address - Country:US
Mailing Address - Phone:907-331-3640
Mailing Address - Fax:907-331-3647
Practice Address - Street 1:2741 DEBARR RD STE C308
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2972
Practice Address - Country:US
Practice Address - Phone:907-331-3640
Practice Address - Fax:907-331-3647
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK145538363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics