Provider Demographics
NPI:1326657388
Name:ALLENDORFER, TONYA FAITH
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:FAITH
Last Name:ALLENDORFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 CATLIN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIAVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48421-8738
Mailing Address - Country:US
Mailing Address - Phone:810-656-6533
Mailing Address - Fax:
Practice Address - Street 1:1075 SUNCREST DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4403
Practice Address - Country:US
Practice Address - Phone:810-667-7333
Practice Address - Fax:810-660-8133
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704216247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily