Provider Demographics
NPI:1114397841
Name:TICHENOR, ALLISON (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:TICHENOR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:LYNN
Other - Last Name:KNOPF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2715 EAST GRAND RIVER AVENUE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912
Mailing Address - Country:US
Mailing Address - Phone:484-515-0495
Mailing Address - Fax:
Practice Address - Street 1:3413 WOODS EDGE
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-5901
Practice Address - Country:US
Practice Address - Phone:517-349-3303
Practice Address - Fax:517-349-4374
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015370363LF0000X
MI4704328748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily