Provider Demographics
NPI:1134168875
Name:GILBERT, ALISON REBECCA (PA-C)
Entity type:Individual
Prefix:MS
First Name:ALISON
Middle Name:REBECCA
Last Name:GILBERT
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 1:3810 BROCKBANK DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3954
Mailing Address - Country:US
Mailing Address - Phone:801-274-2015
Mailing Address - Fax:
Practice Address - Street 1:1717 S J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4933
Practice Address - Country:US
Practice Address - Phone:800-336-8614
Practice Address - Fax:253-838-6418
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0108408512363AM0700X
WAPA60082334363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0249766OtherVCR
WA0249766OtherLIWA
WA1008GIOtherBSWA
WA8543019Medicaid
WA8881406Medicare PIN