Provider Demographics
NPI:1629050950
Name:ALLGOR, JANIE BETH (CNM)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:BETH
Last Name:ALLGOR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JANIE
Other - Middle Name:BETH
Other - Last Name:BOYNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:574-647-1088
Mailing Address - Fax:
Practice Address - Street 1:711 S HEALTH PARKWAY STE 1
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8354
Practice Address - Country:US
Practice Address - Phone:269-273-8557
Practice Address - Fax:269-279-6461
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704147209367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1629050950Medicaid
MI700G560080OtherBCBS GROUP
MI160G510560OtherBCBS GROUP-WOMENS
MI700G560080OtherBCBS GROUP
MIN98720001Medicare ID - Type Unspecified
MI230015Medicare Oscar/Certification