Provider Demographics
NPI:1134692288
Name:LATTA, ALYSSA PAIGE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:PAIGE
Last Name:LATTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:PAIGE
Other - Last Name:STRICKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:575 COAL VALLEY RD STE 464
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3740
Mailing Address - Country:US
Mailing Address - Phone:412-267-6360
Mailing Address - Fax:412-267-6361
Practice Address - Street 1:575 COAL VALLEY RD STE 464
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3740
Practice Address - Country:US
Practice Address - Phone:412-267-6360
Practice Address - Fax:412-267-6361
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060330363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103598108Medicaid
14403474OtherCAQH