Provider Demographics
NPI:1740153410
Name:DILLEY, ALYSSA LEA
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LEA
Last Name:DILLEY
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 1:17817 MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-9120
Mailing Address - Country:US
Mailing Address - Phone:231-750-3033
Mailing Address - Fax:
Practice Address - Street 1:17817 MOHAWK DR
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-9120
Practice Address - Country:US
Practice Address - Phone:231-750-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-27
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
MI4704266593363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No374J00000XNursing Service Related ProvidersDoula