Healthcare Provider Details

I. General information

NPI: 1043855190
Provider Name (Legal Business Name): ALISSA A HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E BRONSON RD
SEYMOUR WI
54165-1040
US

IV. Provider business mailing address

607 E BRONSON RD
SEYMOUR WI
54165-1040
US

V. Phone/Fax

Practice location:
  • Phone: 920-833-6856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: