Provider Demographics
NPI:1336453992
Name:ALLEN, ANDREA E (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:ALLEN
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 AIRPORT HEIGHTS DR STE 210
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2969
Mailing Address - Country:US
Mailing Address - Phone:907-562-6001
Mailing Address - Fax:
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR STE 210
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2969
Practice Address - Country:US
Practice Address - Phone:907-562-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5386363A00000X
AK182673363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2010185Medicaid
WA0270454OtherL&I
WAG8895079OtherMEDICARE
WAG8895079OtherMEDICARE