Provider Demographics
NPI:1134923238
Name:MORTENSON, ALISHA MARIE (PA)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:MARIE
Last Name:MORTENSON
Suffix:
Gender:
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:2856 APPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-8317
Mailing Address - Country:US
Mailing Address - Phone:209-369-2408
Mailing Address - Fax:
Practice Address - Street 1:3104 SUNSET BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3093
Practice Address - Country:US
Practice Address - Phone:916-624-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical