| Provider / Organization | NPI | Date Certified |
|---|---|---|
| ALYSSA LYNN TIDEMANN | 1255910683 | 2021-04-04 |
Alyssa Lynn Tidemann is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1255910683. Registration indicates Alyssa Lynn Tidemann is a provider of services with a specialization in Student, Health Care, Student in an Organized Health Care Education/Training Program (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care)
| Entity Type | Individual |
| Provider Name | Alyssa Lynn Tidemann |
| Practice Office Address | 8701 W WATERTOWN PLANK RD MILWAUKEE, WI US |
| Practice Office Telephone | 4149554575 |
| Mailing Address | 8701 W WATERTOWN PLANK RD MILWAUKEE, WI 532263548 US |
| Code | Practice | License No State |
|---|---|---|
| 390200000X PRIMARY | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care |