Provider Demographics
NPI:1407481120
Name:SCHWANDA, ALYSSA J (PAC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:J
Last Name:SCHWANDA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:J
Other - Last Name:FOSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-387-5511
Mailing Address - Fax:
Practice Address - Street 1:9576 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9067
Practice Address - Country:US
Practice Address - Phone:715-358-1708
Practice Address - Fax:715-358-1180
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI5186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program