Provider Demographics
NPI:1841708229
Name:NAVE, ALLIE JO (PA-C)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:JO
Last Name:NAVE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3860 S STRAITS HWY
Mailing Address - Street 2:
Mailing Address - City:INDIAN RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49749-5146
Mailing Address - Country:US
Mailing Address - Phone:231-238-0581
Mailing Address - Fax:
Practice Address - Street 1:4100 PARK FOREST DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7331
Practice Address - Country:US
Practice Address - Phone:231-935-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601008541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601008541OtherMI DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS