Provider Demographics
NPI:1174973309
Name:BOND, ALYSSA DANIELLE
Entity type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:DANIELLE
Last Name:BOND
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 1:15165 PEBBLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-5189
Mailing Address - Country:US
Mailing Address - Phone:734-620-5158
Mailing Address - Fax:
Practice Address - Street 1:15165 PEBBLEBROOK DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-5189
Practice Address - Country:US
Practice Address - Phone:734-620-5158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-19
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
MI4703128713164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI90-0747294OtherCHITTER CHATTER P.C.