Provider Demographics
NPI:1568830487
Name:RACIC, ALISA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:RACIC
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 1:5327 HUTCHINSON RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-9511
Mailing Address - Country:US
Mailing Address - Phone:139-814-1705
Mailing Address - Fax:513-981-4171
Practice Address - Street 1:5327 HUTCHINSON RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-9511
Practice Address - Country:US
Practice Address - Phone:139-814-1705
Practice Address - Fax:513-981-4171
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant