Healthcare Provider Details

I. General information

NPI: 1710364807
Provider Name (Legal Business Name): ASHLEIGH KAY WISSER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 N CANTON CENTER RD
CANTON MI
48187-5096
US

IV. Provider business mailing address

4856 SPLIT RAIL DR
BRIGHTON MI
48114-7517
US

V. Phone/Fax

Practice location:
  • Phone: 734-495-1506
  • Fax: 734-495-1780
Mailing address:
  • Phone: 734-495-1506
  • Fax: 734-495-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010505
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: