Provider Demographics
NPI:1861921132
Name:JOHNS, ALYSSA (LM, CPM)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:JOHNS
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 E BASELINE RD APT 1091
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4725
Mailing Address - Country:US
Mailing Address - Phone:480-415-2482
Mailing Address - Fax:
Practice Address - Street 1:5332 E.BASELINE RD.
Practice Address - Street 2:APT. 1091
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-415-2482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLM207176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife