Provider Demographics
NPI:1821343450
Name:LUELLEN, ALLISON (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:LUELLEN
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 1:1200 WESTVIEW LN
Mailing Address - Street 2:APARTMENT 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-3269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8350 COLORADO BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504
Practice Address - Country:US
Practice Address - Phone:303-689-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59171553Medicaid