Provider Demographics
NPI:1124119920
Name:ADAMS, ALLISON (PA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:3221 32ND AVE S STE 700
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6075
Mailing Address - Country:US
Mailing Address - Phone:701-335-4380
Mailing Address - Fax:701-772-0324
Practice Address - Street 1:3221 32ND AVE S STE 700
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6075
Practice Address - Country:US
Practice Address - Phone:701-335-4380
Practice Address - Fax:701-772-0324
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0131363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18338Medicare PIN
S86405Medicare UPIN