Provider Demographics
NPI:1407619612
Name:PYBURN, ALYSSA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANN
Last Name:PYBURN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3484B 3RD LN
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53952-9416
Mailing Address - Country:US
Mailing Address - Phone:630-310-9554
Mailing Address - Fax:
Practice Address - Street 1:1200 LAGOON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2077
Practice Address - Country:US
Practice Address - Phone:612-823-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant