Provider Demographics
NPI:1386995744
Name:AMLIE, ALLISON R (PA-C)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:R
Last Name:AMLIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:R
Other - Last Name:SCHENK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2836 COLFAX AVE S
Mailing Address - Street 2:APT. E438
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4850
Mailing Address - Country:US
Mailing Address - Phone:651-283-6657
Mailing Address - Fax:
Practice Address - Street 1:717 DELAWARE ST SE STE 353
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2959
Practice Address - Country:US
Practice Address - Phone:612-625-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11557363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical