Healthcare Provider Details

I. General information

NPI: 1750897245
Provider Name (Legal Business Name): ALEAH CHARITY WYSOZAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E SHERMAN BLVD SUITE 2400
MUSKEGON MI
49444-1849
US

IV. Provider business mailing address

5227 AIRLINE RD
MUSKEGON MI
49444-9727
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-4243
  • Fax: 231-727-4214
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: