Provider Demographics
NPI:1003895095
Name:STITT, ALYSSA L (MD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:L
Last Name:STITT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 8674
Mailing Address - Street 2:1230 E MAIN ST
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1230 E MAIN STREET
Practice Address - Street 2:MANKATO CLINIC
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56002-8674
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN48055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0121464OtherMEDICA MN
HP55624OtherHEALTH PARTNERS MN
135337OtherUCARE MN
399G0STOtherBCBS MN
NA2951044642OtherPREFERRED ONE MN
2374570OtherAMERICAS PPO MN
MN699407500Medicaid
HP55624OtherHEALTH PARTNERS MN
2374570OtherAMERICAS PPO MN