Provider Demographics
NPI:1629415922
Name:LAKIN, ALYSSA (PA C)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:
Last Name:LAKIN
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 1:4909 N GLEN PARK PLACE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4676
Mailing Address - Country:US
Mailing Address - Phone:563-652-6711
Mailing Address - Fax:563-652-6715
Practice Address - Street 1:206 N ARCADE
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2022
Practice Address - Country:US
Practice Address - Phone:563-652-6711
Practice Address - Fax:563-652-6715
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine