Provider Demographics
NPI:1801523808
Name:MCALLISTER, MARC (NP (AGPCNP))
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:NP (AGPCNP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8855 KEREMEOS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1419
Mailing Address - Country:US
Mailing Address - Phone:858-243-8686
Mailing Address - Fax:
Practice Address - Street 1:8855 KEREMEOS WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-1419
Practice Address - Country:US
Practice Address - Phone:858-243-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95021135363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPF95021135OtherNURSE PRACTITIONER FURNISHING NUMBER