Provider Demographics
NPI:1629408968
Name:MCMAHON, ALISSA MARIE (ALISSA MCMAHON, PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ALISSA
Middle Name:MARIE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:ALISSA MCMAHON, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 WINDSOR WAY UNIT 3
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-2825
Mailing Address - Country:US
Mailing Address - Phone:702-335-0289
Mailing Address - Fax:
Practice Address - Street 1:1447 WINDSOR WAY UNIT 3
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-2825
Practice Address - Country:US
Practice Address - Phone:702-335-0289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-23
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1474363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant