Provider Demographics
NPI:1689134694
Name:ALLEN, PATRICK JAMES (NP)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JAMES
Last Name:ALLEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E STADIUM BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4616
Mailing Address - Country:US
Mailing Address - Phone:734-769-3333
Mailing Address - Fax:734-769-6666
Practice Address - Street 1:1000 E STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4616
Practice Address - Country:US
Practice Address - Phone:734-769-3333
Practice Address - Fax:734-769-6666
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704321472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily