Provider Demographics
NPI:1568830487
Name:EARLE, ALISA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:MARIE
Last Name:EARLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:MARIE
Other - Last Name:RACIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5327 HUTCHINSON RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-9511
Mailing Address - Country:US
Mailing Address - Phone:139-814-1705
Mailing Address - Fax:513-981-4171
Practice Address - Street 1:5327 HUTCHINSON RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-9511
Practice Address - Country:US
Practice Address - Phone:139-814-1705
Practice Address - Fax:513-981-4171
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC172363A00000X
OH363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant