Basic Information
Provider Information
NPI: 1669649919
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUGHES
FirstName: ALETHIA
MiddleName: F
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10001 W INNOVATION DR STE 200
Address2:  
City: MILWAUKEE
State: WI
PostalCode: 532264851
CountryCode: US
TelephoneNumber: 8889383838
FaxNumber: 8889191083
Practice Location
Address1: 247 S NICOLET RD
Address2:  
City: APPLETON
State: WI
PostalCode: 549143938
CountryCode: US
TelephoneNumber: 8889383838
FaxNumber: 8889191083
Other Information
ProviderEnumerationDate: 05/14/2008
LastUpdateDate: 06/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X2223WIY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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