Provider Demographics
NPI:1801149976
Name:STAFFORD, ALLISON M (PA-C)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:M
Other - Last Name:MANDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3409 LUDINGTON STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829
Mailing Address - Country:US
Mailing Address - Phone:906-789-4414
Mailing Address - Fax:906-789-4406
Practice Address - Street 1:3409 LUDINGTON STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829
Practice Address - Country:US
Practice Address - Phone:906-789-4414
Practice Address - Fax:906-789-4406
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006543363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1715928Medicaid