Healthcare Provider Details

I. General information

NPI: 1598471120
Provider Name (Legal Business Name): ALYSSA CATHERINE QUAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2844 INDEX RD
FITCHBURG WI
53713-3117
US

IV. Provider business mailing address

2844 INDEX RD
FITCHBURG WI
53713-3117
US

V. Phone/Fax

Practice location:
  • Phone: 608-229-7979
  • Fax:
Mailing address:
  • Phone: 608-229-7979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7242-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: