Provider Demographics
NPI:1649912908
Name:HABERER, ALYSSA JORDAN (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JORDAN
Last Name:HABERER
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 1:700 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57442-1902
Mailing Address - Country:US
Mailing Address - Phone:605-769-0242
Mailing Address - Fax:
Practice Address - Street 1:1601 HIGHWAY 13 E
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6865
Practice Address - Country:US
Practice Address - Phone:952-405-9760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant