ALYSA BLUM (NPI# 1093140816) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093140816 |
| Entity Type | Individual |
| Full Name | ALYSA BLUM |
| Other Name | ALYSA MCGOVERN |
| Credential | PA-C |
| Practice Address |
615 W Moreland Blvd Waukesha WI 53188-2462 |
| Practice Telephone | 2628968420 |
| Practice Fax Number | 2628968521 |
| Mailing Telephone | 2628968429 |
| Mailing Fax Number | 2628968521 |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2014-12-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 3150-23 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | DEA | MB3031957 | 01 |
| Street Address |
615 W MORELAND BLVD |
| City | WAUKESHA |
| State | WI |
| Zip Code | 53188-2462 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306913801 | Darren James Rausch | Specialist/Technologist, Other | 615 W Moreland Blvd, Waukesha, WI 53188-2462 | 2006-11-29 |
| 1164065876 | Natasha Schultz | Nutritionist | 615 W Moreland Blvd, Waukesha, WI 53188-2462 | 2019-10-25 |
| 1700309911 | Courtney S Handeland | Health Educator | 615 W Moreland Blvd, Waukesha, WI 53188-2462 | 2017-07-19 |
| 1891218053 | Allison Knight | Dietetic Technician, Registered | 615 W Moreland Blvd, Waukesha, WI 53188-2462 | 2017-07-19 |
| 1174930432 | Healthstat Onsite Clinic- Waukesa | Preventive Medicine | 615 W Moreland Blvd, Waukesha, WI 53188-2462 | 2014-07-18 |
| 1770847238 | Mary Jo Michels | Dietitian, Registered | 615 W Moreland Blvd, Waukesha, WI 53188-2462 | 2012-06-29 |
| 1093073421 | Carly Chicantek | Registered Nurse | 615 W Moreland Blvd, Waukesha, WI 53188-2462 | 2012-04-23 |
| 1376839134 | Barbara Janet Spain | Technician, Other | 615 W Moreland Blvd, Waukesha, WI 53188-2462 | 2011-06-21 |
| 1003121815 | Ariane Margaret Grudzina | Registered Nurse | 615 W Moreland Blvd, Waukesha, WI 53188-2462 | 2010-08-17 |
| 1518271709 | Jessica Irene Lukas | Technician, Other | 615 W Moreland Blvd, Waukesha, WI 53188-2462 | 2010-07-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336787126 | Nicole Lee Berg-johnson | Nurse Practitioner | 820 Crestwood Dr., Waukesha, WI 53188 | 2019-12-12 |
| 1013475706 | Rachel Mueller | Occupational Therapist | 29667 Summit Ave, S11, Waukesha, WI 53188 | 2019-03-12 |
| 1861962649 | Emily Elizabeth Seefeld | Occupational Therapy Assistant | 29667 Summit Ave S11, Waukesha, WI 53188 | 2018-12-05 |
| 1003393307 | Ashley Susan Callahan | Dental Hygienist | 711 W. Moreland Blvd., Suite 204, Waukesha, WI 53188 | 2018-07-19 |
| 1245741321 | Melissa Weir | Case Manager/Care Coordinator | 514 Riverview Avenue, Waukesha, WI 53188 | 2017-10-17 |
| 1093233629 | Patricia Marie Sombrio | Dental Hygienist | 711 Moreland Blvd 204, Waukesha, WI 53188 | 2017-09-04 |
| 1134660244 | Bdg of Wisconsin, Inc. | Behavioral Analyst | N19w2309 Riverwood Drive, Suite 350 Pmb 314, Waukesha, WI 53188 | 2017-03-09 |
| 1255888731 | Lynne Sarah Alva | Dental Hygienist | 711 Moreland Blvd, Suite 204, Waukesha, WI 53188 | 2016-09-01 |
| 1881069730 | Michelle Koch | Occupational Therapist | 29667 Summit Ave. S11, Waukesha, WI 53188 | 2015-12-03 |
| 1952711012 | Rhonda Schroeder | Dental Hygienist | W286 N991 Shepherds Way, Waukesha, WI 53188 | 2014-04-29 |
| Find all providers in zip 53188 | ||||
| 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 |
|---|---|---|---|---|
| 1003434978 | Benjamin Alton Cuvelier | Physician Assistant | 132 Cambridge Ave Apt 407, Waukesha, WI 53188-4788 | 2020-07-08 |
| 1275159428 | Breanna Evert | Physician Assistant | 2320 Parklawn Dr # C111, Waukesha, WI 53186-2954 | 2020-06-23 |
| 1902257819 | Jennifer Treena Elizabeth Hunt | Physician Assistant | 2140 Davidson Rd, Waukesha, WI 53186-4008 | 2016-06-22 |
| 1396141156 | Amanda Klimek | Physician Assistant | 1117 Oxford Rd, Waukesha, WI 53186-6475 | 2014-11-06 |
| 1629080932 | William L Mustas | Physician Assistant | 1111 Delafield St Ste 215, Waukesha, WI 53188-3403 | 2006-08-13 |
| 1467425082 | Lisa L. Thinnes | Physician Assistant | Prohealth Care Medical Associates Inc., 2130 Big Bend Rd, Waukesha, WI 53189-7624 | 2006-02-13 |
| 1225014236 | Shari K Villa | Physician Assistant | 717 W Moreland Blvd, Prohealth Care Medical Associates Moreland Family Medic, Waukesha, WI 53188-2432 | 2005-12-21 |
| 1558969568 | Rachelle Parker | Physician Assistant | 100 N East Ave, Waukesha, WI 53186-3103 | 2020-10-12 |
| 1215557566 | Rachel Renee Poenitsch | Physician Assistant | 100 N East Ave, Waukesha, WI 53186-3103 | 2020-04-16 |
| 1841828613 | Carrie Siekierski | Physician Assistant | 100 N East Ave, Waukesha, WI 53186-3103 | 2020-03-29 |
| Find all providers in WAUKESHA | ||||
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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.