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Individual
MRS. ALISSA MARIE MCCORMACK
Active
Individual
MRS. ALISSA MARIE MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3448
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4059PA
—
SC
01
—
SCH1535019
MEDICARE PIN
SC
Enumeration date
01/06/2020
Last updated
10/09/2024
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