Provider Demographics
NPI:1750174157
Name:MARTONE, ALYSSA KIRSTEN (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KIRSTEN
Last Name:MARTONE
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 1:100 W 5TH ST APT 614
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2561
Mailing Address - Country:US
Mailing Address - Phone:248-410-3545
Mailing Address - Fax:
Practice Address - Street 1:100 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2559
Practice Address - Country:US
Practice Address - Phone:248-410-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MI5601013190363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant