Provider Demographics
NPI:1679964662
Name:MCLEAN, ALLYSON (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 N 3RD AVE # 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4434
Mailing Address - Country:US
Mailing Address - Phone:602-406-7868
Mailing Address - Fax:602-294-8287
Practice Address - Street 1:2910 N 3RD AVE # 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4434
Practice Address - Country:US
Practice Address - Phone:602-406-7868
Practice Address - Fax:602-294-8287
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ248403363LA2100X
COAPN .0991630363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO23601752Medicaid
AZ085006Medicaid