Healthcare Provider Details

I. General information

NPI: 1669314167
Provider Name (Legal Business Name): ALYSSA GRACE COLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N NINE MOUND RD
MADISON WI
53593-1828
US

IV. Provider business mailing address

1100 DELAPLAINE CT
MADISON WI
53715-1840
US

V. Phone/Fax

Practice location:
  • Phone: 608-845-9531
  • Fax: 608-845-8684
Mailing address:
  • Phone: 608-263-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: