Provider Demographics
NPI:1649577057
Name:GALE, ALINA COLLAR (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALINA
Middle Name:COLLAR
Last Name:GALE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALINA
Other - Middle Name:STOMANT
Other - Last Name:COLLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4069 LAKE DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8816
Practice Address - Country:US
Practice Address - Phone:616-267-7015
Practice Address - Fax:616-267-7818
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005959363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical