Provider Demographics
NPI:1194029157
Name:MCLELLAN, ALISON (PA-C)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:MCLELLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 W THUNDERBIRD RD STE 308
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4710
Mailing Address - Country:US
Mailing Address - Phone:623-412-2229
Mailing Address - Fax:602-314-5843
Practice Address - Street 1:5310 W THUNDERBIRD RD STE 308
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4710
Practice Address - Country:US
Practice Address - Phone:623-412-2229
Practice Address - Fax:602-314-5843
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3510363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant