Provider Demographics
NPI:1013395078
Name:EISNER, ALYSSA KATHRYN (PA)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:KATHRYN
Last Name:EISNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:KATHRYN
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3403
Mailing Address - Country:US
Mailing Address - Phone:262-542-0444
Mailing Address - Fax:262-542-8214
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 209
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3403
Practice Address - Country:US
Practice Address - Phone:262-542-0444
Practice Address - Fax:262-542-8214
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1013395078Medicaid
WI3568-23OtherWI STATE LICENSE
WI1121321OtherNCCPA