Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 76475-21 | WI |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 8221851 | WI |
NPI | 1003475005 |
---|---|
Provider Name | Alyssa Warden |
First Address | Madison, WI 53705-1465 |
Second Address | Madison, WI 53792-7815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2019 |
Last Update Date | 17/01/2022 |