Provider Demographics
NPI:1689437196
Name:WISLOTSKY, ALEXIS ADRIANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ADRIANNA
Last Name:WISLOTSKY
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 1:574 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17921-9125
Mailing Address - Country:US
Mailing Address - Phone:570-933-0921
Mailing Address - Fax:
Practice Address - Street 1:1665 VALLEY CENTER PKWY STE 130
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-2352
Practice Address - Country:US
Practice Address - Phone:610-317-0208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065282363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical