Provider Demographics
NPI:1245825769
Name:OLSHOVE, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:OLSHOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13634 N 93RD AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4915
Mailing Address - Country:US
Mailing Address - Phone:623-815-2484
Mailing Address - Fax:623-815-2483
Practice Address - Street 1:13634 N 93RD AVE STE 300
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4915
Practice Address - Country:US
Practice Address - Phone:623-815-2484
Practice Address - Fax:623-815-2483
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
AZ8712363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid