Healthcare Provider Details

I. General information

NPI: 1629364815
Provider Name (Legal Business Name): ALYSSA M RICCHIO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA M WILSON PA-C

II. Dates (important events)

Enumeration Date: 06/26/2011
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 242ND AVE
SALEM WI
53168-9483
US

IV. Provider business mailing address

7525 242ND AVE
SALEM WI
53168-9483
US

V. Phone/Fax

Practice location:
  • Phone: 262-316-7103
  • Fax: 262-316-7123
Mailing address:
  • Phone: 262-316-7103
  • Fax: 262-316-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2769-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: