Disrud, Alexandra Denise

Disrud, Alexandra Denise is an individual health care provider with primary practice located at 36500 Aurora Dr , Summit WI 53066. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Disrud, Alexandra Denise can be contacted via phone (262) 434-1000.

Contact Information

Primary practice address
36500 Aurora Dr Summit WI 53066
Phone: (262) 434-1000
Fax: (262) 434-5050
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X

Profile Details

NPI number 1053831487
LBN Legal business name Disrud, Alexandra Denise
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 27th, 2017
Last updated Dec 1st, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053831487 NPPES
Wisconsin MEDICAID 1053831487

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