Provider Demographics
NPI:1740255835
Name:VENTURA, ALISSA S (PA-C)
Entity type:Individual
Prefix:MS
First Name:ALISSA
Middle Name:S
Last Name:VENTURA
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:9825 HOSPITAL DR
Mailing Address - Street 2:STE 105
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4479
Mailing Address - Country:US
Mailing Address - Phone:763-780-6699
Mailing Address - Fax:763-420-0500
Practice Address - Street 1:9825 HOSPITAL DR STE 105
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4769
Practice Address - Country:US
Practice Address - Phone:763-780-6699
Practice Address - Fax:763-420-0500
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2019-12-04
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Provider Licenses
StateLicense IDTaxonomies
MN9911363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN078475300Medicaid
MNQ28428Medicare UPIN
MN078475300Medicaid