Provider Demographics
NPI:1861700627
Name:VAN PUTTEN-LAGUERRE, ALANA ANISE (NMD, PA-C)
Entity type:Individual
Prefix:MS
First Name:ALANA
Middle Name:ANISE
Last Name:VAN PUTTEN-LAGUERRE
Suffix:
Gender:F
Credentials:NMD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 COUNTY ROAD 250
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-5034
Mailing Address - Country:US
Mailing Address - Phone:301-655-5989
Mailing Address - Fax:
Practice Address - Street 1:5638 HIGHWAY 53 UNIT B195
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-8555
Practice Address - Country:US
Practice Address - Phone:256-346-8185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004153363A00000X
GA8387363A00000X
VT0990134041175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant