Provider Demographics
NPI:1437626751
Name:ALLISON-SHAMBLIN, JANEL LEA (PA-C)
Entity Type:Individual
Prefix:
First Name:JANEL
Middle Name:LEA
Last Name:ALLISON-SHAMBLIN
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 1:1232 N 15TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3299
Mailing Address - Country:US
Mailing Address - Phone:406-585-3700
Mailing Address - Fax:
Practice Address - Street 1:1232 N 15TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3299
Practice Address - Country:US
Practice Address - Phone:406-585-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT69720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant