Provider Demographics
NPI:1265298459
Name:HARRISON, ALEXANDRIA ANNE (AGPNP-BC, CANS)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:ANNE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:AGPNP-BC, CANS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5367 QUARRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-4944
Mailing Address - Country:US
Mailing Address - Phone:608-434-0962
Mailing Address - Fax:
Practice Address - Street 1:507 LINN ST STE E
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1187
Practice Address - Country:US
Practice Address - Phone:608-509-7655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2023190145363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health