Provider Demographics
NPI:1447981451
Name:BLAND, ALYSSA KATHARINE (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KATHARINE
Last Name:BLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 THREE MILE RUN RD
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-2025
Mailing Address - Country:US
Mailing Address - Phone:215-804-6520
Mailing Address - Fax:
Practice Address - Street 1:2050 THREE MILE RUN RD
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-2025
Practice Address - Country:US
Practice Address - Phone:215-804-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
PAMA063725363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant