Provider Demographics
NPI:1497453153
Name:ALLEN, CLAIRE MAGDALYN (PA-C)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:MAGDALYN
Last Name:ALLEN
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 1:54546 MEADOW CREST CIR
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-6302
Mailing Address - Country:US
Mailing Address - Phone:586-744-3398
Mailing Address - Fax:
Practice Address - Street 1:34025 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-3737
Practice Address - Country:US
Practice Address - Phone:586-210-9170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011560363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant