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Individual

ALYSSA S DEPPONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT

Contact information

Practice address
12500 AURORA DR, PLEASANT PRAIRIE, WI 53158-1227
(262) 857-5000
Mailing address
12500 AURORA DR, PLEASANT PRAIRIE, WI 53158-1227
(262) 857-5000

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
4736-23
WI
363A00000X
Physician Assistant
Primary
4736-23
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100091500
WI
Enumeration date
07/01/2019
Last updated
12/05/2022
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