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General NPI Number Information
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NPI Number | 1336335934
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Entity Type | Individual
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Provider Name | ALYSSA N TRUONG PA
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Gender | Female
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 10800 W CAPITOL DR
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City | WAUWATOSA
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State | WI
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Zip | 53222-1109
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Country | US
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Telephone | 414-462-2373
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Fax | 414-462-2393
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone | 414-462-2373
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Fax | 414-462-2393
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085003212
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2192-23
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License Number State | WI
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