ALYSSA WENTWORTH (NPI# 1699232132) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699232132 |
| Entity Type | Individual |
| Full Name | ALYSSA WENTWORTH |
| Credential | PA-C |
| Practice Address |
1405 Mill St New London WI 54961-2155 |
| Mailing Address |
140 Kelly Way Apt 8 Hortonville WI 54944-8736 |
| Practice Telephone | 9205312400 |
| Mailing Telephone | 9206600231 |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2020-07-15 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 5146-23 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3494 Edinburgh Rd, Green Bay, WI 543117284 | 9206600231 |
| Street Address |
1405 MILL ST |
| City | NEW LONDON |
| State | WI |
| Zip Code | 54961-2155 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598752057 | Hiep T Poppy | Physical Therapy Assistant | 1405 Mill St, New London, WI 54961-2155 | 2005-09-30 |
| 1952918328 | Emily Becher | Physical Therapist | 1405 Mill St, New London, WI 54961-2155 | 2020-09-29 |
| 1609390855 | Leah M Lemke | Physician Assistant | 1405 Mill St, New London, WI 54961-2155 | 2017-07-31 |
| 1548783228 | Kelsey Mae Abendroth | Physical Therapist | 1405 Mill St, New London, WI 54961-2155 | 2017-07-25 |
| 1609397280 | Mayka L Rambo | Registered Nurse | 1405 Mill St, New London, WI 54961-2155 | 2017-07-04 |
| 1275087207 | Ryan Wagner | Emergency Medicine | 1405 Mill St, New London, WI 54961-2155 | 2016-08-08 |
| 1679932750 | Kristin M Roesler | Nurse Practitioner | 1405 Mill St, New London, WI 54961-2155 | 2016-02-17 |
| 1740675040 | Bryan Kent Hendrickson | Family Medicine | 1405 Mill St, New London, WI 54961-2155 | 2015-04-02 |
| 1972928463 | New London Family Medical Center Inc | Non-Pharmacy Dispensing Site | 1405 Mill St, New London, WI 54961-2155 | 2014-02-20 |
| 1063846491 | Courtney Nicole Shirel | Physical Therapist | 1405 Mill St, New London, WI 54961-2155 | 2013-08-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407406408 | Cheryl Schneider | Technician | L 56 Northgate Estates, New London, WI 54961 | 2019-09-12 |
| 1861634719 | Rebecca L Kramer | Counselor | 315 Burton St, New London, WI 54961 | 2009-03-24 |
| 1598913501 | Marsha Ann Nytes | Licensed Practical Nurse | E8222 Weyawega Rd, New London, WI 54961 | 2008-09-03 |
| 1659585172 | Amanda L. Beck | Physical Therapy Assistant | 400 E. 4th Street, Manawa, WI 54961 | 2007-05-10 |
| 1366599433 | Griebenow Eyecare, S.c. | Optometrist | 105 Northridge Drive, New London, WI 54961 | 2007-01-04 |
| 1740822055 | Lauren Mae Flunker | Social Worker | E7475 Rawhide Rd, New London, WI 54961 | 2019-10-09 |
| 1063641249 | Forefront Dermatology, S.c. | Dermatology | 1620 N Shawano St, Suite C, New London, WI 54961 | 2009-07-08 |
| 1093982530 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1420 Algoma St, New London, WI 54961 | 2008-05-14 |
| 1821263849 | Mark Alan Tegtmeier | Counselor | E7475 Rawhide Rd, New London, WI 54961 | 2008-04-30 |
| 1639282544 | Ascension Medical Group-fox Valley Wisconsin, Inc | Durable Medical Equipment & Medical Supplies | 1420 Algoma St, New London, WI 54961 | 2006-08-16 |
| Find all providers in zip 54961 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679712053 | Elizabeth Mann | Physician Assistant | 365 Montauk Ave Ste 2.013, Lmh Urology, New London, CT 06320-4700 | 2009-02-09 |
| 1407936875 | Sarah F Whalen | Physician Assistant | 45 Franklin Street, New London, CT 06320 | 2006-10-17 |
| 1255371217 | Jason Lee Tharpe | Physician Assistant | 194 Howard St, New London, CT 06320-5544 | 2006-06-07 |
| 1700859006 | Richard Dominick Moro | Physician Assistant | 435 Montauk Ave, New London, CT 06320-4621 | 2006-02-08 |
| 1689204919 | Colleen Mccue | Physician Assistant | 15 Mohegan Ave, New London, CT 06320-8100 | 2020-01-26 |
| 1285190462 | Keren Mariam Paul | Physician Assistant | 365 Montauk Ave, New London, CT 06320-4700 | 2019-02-13 |
| 1124590930 | Abbey Rumbold | Physician Assistant | 365 Montauk Ave, New London, CT 06320-4769 | 2018-12-19 |
| 1902324205 | Marissa Tennant | Physician Assistant | 365 Montauk Ave, New London, CT 06320-4700 | 2017-09-07 |
| 1841717535 | Laura Hoover | Physician Assistant | 365 Montauk Ave, New London, CT 06320-4700 | 2017-08-24 |
| 1609390855 | Leah M Lemke | Physician Assistant | 1405 Mill St, New London, WI 54961-2155 | 2017-07-31 |
| Find all providers in NEW LONDON | ||||
| City | NEW LONDON |
| Zip Code | 54961 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.