Provider Demographics
NPI:1407105349
Name:ALLEN, LINDSAY MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:MARIE
Other - Last Name:STEPHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 W PATERSON ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-2557
Mailing Address - Country:US
Mailing Address - Phone:269-349-2641
Mailing Address - Fax:269-349-2898
Practice Address - Street 1:5973 BEATRICE DRIVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009
Practice Address - Country:US
Practice Address - Phone:269-286-7110
Practice Address - Fax:269-286-7111
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant