Provider Demographics
NPI:1134214042
Name:WAITKUS, ALYSSA R (PA)
Entity type:Individual
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First Name:ALYSSA
Middle Name:R
Last Name:WAITKUS
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Gender:F
Credentials:PA
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Mailing Address - Street 1:12801 IRON BRIDGE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1669
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-0999
Practice Address - Fax:804-628-0384
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-01-19
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Provider Licenses
StateLicense IDTaxonomies
VA0110002172363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant