Healthcare Provider Details

I. General information

NPI: 1831035385
Provider Name (Legal Business Name): ALLYSON GRACE MITCHELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 S MOORLAND RD
NEW BERLIN WI
53151-7401
US

IV. Provider business mailing address

6381 209TH ST N
FOREST LAKE MN
55025-8063
US

V. Phone/Fax

Practice location:
  • Phone: 262-798-7200
  • Fax: 262-798-7201
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: