Provider Demographics
NPI:1669099412
Name:SCHRUMP, ALISA ELAINE (PA)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:ELAINE
Last Name:SCHRUMP
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7618 OLD HICKORY CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46259-9575
Mailing Address - Country:US
Mailing Address - Phone:317-478-6560
Mailing Address - Fax:
Practice Address - Street 1:7618 OLD HICKORY CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46259-9575
Practice Address - Country:US
Practice Address - Phone:317-478-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant