Provider Demographics
NPI:1194343897
Name:POLAND, ALYSSA KAY (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:KAY
Last Name:POLAND
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 1:10006 W LOS GATOS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3343
Mailing Address - Country:US
Mailing Address - Phone:678-925-8446
Mailing Address - Fax:
Practice Address - Street 1:10006 W LOS GATOS DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-3343
Practice Address - Country:US
Practice Address - Phone:678-925-8446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical