Provider Demographics
NPI:1851451371
Name:WIX, ALISON BLAKE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:BLAKE
Last Name:WIX
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:N
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:701 BROAD ST.
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143
Mailing Address - Country:US
Mailing Address - Phone:412-749-9868
Mailing Address - Fax:412-749-9729
Practice Address - Street 1:701 BROAD ST.
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143
Practice Address - Country:US
Practice Address - Phone:412-749-9868
Practice Address - Fax:412-749-9729
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052419363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA115202UWMMedicare PIN
PAQ63825Medicare UPIN