Individual
ALEXANDRA DENISE DISRUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
36500 AURORA DR, SUMMIT, WI 53066
(262) 434-1000
(262) 434-5050
Mailing address
36500 AURORA DR, SUMMIT, WI 53066-4899
(262) 434-1000
(262) 434-5050
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053831487
—
WI
Enumeration date
06/27/2017
Last updated
12/01/2021
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