Provider Demographics
NPI:1386280071
Name:BUTRIE, ALLISON ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANNE
Last Name:BUTRIE
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 1:226 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1515
Mailing Address - Country:US
Mailing Address - Phone:570-249-0229
Mailing Address - Fax:
Practice Address - Street 1:528 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1911
Practice Address - Country:US
Practice Address - Phone:610-900-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061231363AM0700X
PAOA005070363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical