Healthcare Provider Details

I. General information

NPI: 1780401661
Provider Name (Legal Business Name): ALYSHA BRICKL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N COMMERCIAL ST STE 100
NEENAH WI
54956-2675
US

IV. Provider business mailing address

2000 UNIVERSITY AVE
DUBUQUE IA
52001-5099
US

V. Phone/Fax

Practice location:
  • Phone: 920-336-4096
  • Fax: 920-336-8093
Mailing address:
  • Phone: 563-589-3662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8818-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: