MEDICARE: ALYSSA ROSE FORSLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	10987-33	WI
2	363LF0000X	Family Nurse Practitioner	10987	WI
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10987	WI

General Provider Information

NPI Number	:	1730756909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA ROSE FORSLIN

Provider Business Mailing Address
First Line	:	3 NEENAH CTR
Second Line	:
City	:	NEENAH
State	:	WI
Zip	:	54956-3070
Country	:	US
Telephone Number	:	920-720-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 PARK AVE
Second Line	:
City	:	WAUPACA
State	:	WI
Zip	:	54981-1956
Country	:	US
Telephone Number	:	920-720-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	09/26/2024

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Directions to “ ALYSSA ROSE FORSLIN ” Practice Location

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