Individual
ALISSA NONGYAO WORSTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1701 S CREASY LN, LAFAYETTE, IN 47905-4972
(765) 502-4000
(765) 504-4687
Mailing address
PO BOX 78838, DETROIT, MI 48278-0838
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28182413A
IN
367500000X
Certified Registered Nurse Anesthetist
28182413C
IN
367500000X
Certified Registered Nurse Anesthetist
CERTIFICATE # 080969
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000610409
ANTHEM PROVIDER NUMBER
IN
05
—
200948140
—
IN
Enumeration date
04/07/2009
Last updated
10/20/2023
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