Provider Demographics
NPI:1669605481
Name:GUNDERSON, ALLISON CRANE (PA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:CRANE
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX HMD
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-4912
Mailing Address - Fax:585-271-2106
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX HMD
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-4912
Practice Address - Fax:585-271-2106
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13423363AM0700X
NY013423363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03142312Medicaid
NYJ400008665/GP 70008AMedicare PIN
NYJ400005878/GP BA0017Medicare PIN