Provider Demographics
NPI:1770860033
Name:CLAY, ALARISE JACQUELYN (PA-C, MCEP)
Entity Type:Individual
Prefix:
First Name:ALARISE
Middle Name:JACQUELYN
Last Name:CLAY
Suffix:
Gender:F
Credentials:PA-C, MCEP
Other - Prefix:
Other - First Name:ALARISE
Other - Middle Name:JACQUELYN
Other - Last Name:MANNHALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 PRAIRIE ROSE DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-4314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1305 PRAIRIE ROSE DR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-4314
Practice Address - Country:US
Practice Address - Phone:608-828-7603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5349-23363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant