Provider Demographics
NPI:1801529953
Name:HALSOR, ALLIE RAE (PA-C)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:RAE
Last Name:HALSOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:RAE
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6510 OERSTED RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-6562
Mailing Address - Country:US
Mailing Address - Phone:505-610-1950
Mailing Address - Fax:
Practice Address - Street 1:6510 OERSTED RD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-6562
Practice Address - Country:US
Practice Address - Phone:505-610-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant