Healthcare Provider Details

I. General information

NPI: 1982613246
Provider Name (Legal Business Name): ALYSSA R HOVERSON SCHOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA R HOVERSON MD

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 32ND AVE S STE 700
GRAND FORKS ND
58201-6075
US

IV. Provider business mailing address

2720 FAIRVIEW AVE N STE 200
ROSEVILLE MN
55113-1306
US

V. Phone/Fax

Practice location:
  • Phone: 651-633-6883
  • Fax: 651-331-3459
Mailing address:
  • Phone: 651-633-6883
  • Fax: 651-331-3459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMN-48913
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number48913
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number40404
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number11319
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: