Provider Demographics
NPI:1912007915
Name:LEVENICK, ALISON BRIANNA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ALISON
Middle Name:BRIANNA
Last Name:LEVENICK
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 1:5201 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4902
Mailing Address - Country:US
Mailing Address - Phone:414-963-0500
Mailing Address - Fax:414-963-0359
Practice Address - Street 1:5201 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-4902
Practice Address - Country:US
Practice Address - Phone:414-963-0500
Practice Address - Fax:414-963-0359
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23-1776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIQ26657Medicare UPIN