Provider Demographics
NPI:1982662227
Name:OSIS, ALISE A (PA-C)
Entity Type:Individual
Prefix:
First Name:ALISE
Middle Name:A
Last Name:OSIS
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 1:620 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73019-3146
Mailing Address - Country:US
Mailing Address - Phone:405-325-4611
Mailing Address - Fax:405-325-7065
Practice Address - Street 1:620 ELM AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73019-3146
Practice Address - Country:US
Practice Address - Phone:405-325-4611
Practice Address - Fax:405-325-7065
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001178363A00000X
MO2007028409363A00000X
OKPA2036363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00657552OtherRR MEDICARE
MO000097543Medicare PIN
ME0013845Medicare PIN
MOP00657552OtherRR MEDICARE