Provider Demographics
NPI:1487130985
Name:PYC, ALLISON L (FNP-C)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:L
Last Name:PYC
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:L
Other - Last Name:DINSMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1639 E BIG BEAVER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2053
Mailing Address - Country:US
Mailing Address - Phone:248-289-7300
Mailing Address - Fax:248-289-7301
Practice Address - Street 1:1639 E BIG BEAVER RD STE 103
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2053
Practice Address - Country:US
Practice Address - Phone:248-289-7300
Practice Address - Fax:248-289-7301
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1437161437Medicaid
MI1487130985Medicaid