Individual
ALISE A OSIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2007028409
MO
363A00000X
Physician Assistant
PA001178
ME
363AM0700X
Medical Physician Assistant
Primary
PA2036
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00657552
RR MEDICARE
MO
Enumeration date
05/03/2006
Last updated
09/27/2011
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