Provider Demographics
NPI:1356074512
Name:FLAGGE, ALYSSA JEAN
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JEAN
Last Name:FLAGGE
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 1:1101 E KELLY CT
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-7947
Mailing Address - Country:US
Mailing Address - Phone:414-899-6412
Mailing Address - Fax:
Practice Address - Street 1:1101 E KELLY CT
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-7947
Practice Address - Country:US
Practice Address - Phone:414-899-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program