Provider Demographics
NPI:1528871605
Name:HUMAGAIN, ALISHA
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:HUMAGAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W162N4914 GRAYSLAND DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-7540
Mailing Address - Country:US
Mailing Address - Phone:262-875-0571
Mailing Address - Fax:
Practice Address - Street 1:W162N4914 GRAYSLAND DR
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-7540
Practice Address - Country:US
Practice Address - Phone:847-751-2784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIF01250874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily