Provider Demographics
NPI:1528254596
Name:HANSEL ALLEN, PAULA JEAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:JEAN
Last Name:HANSEL ALLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:JEAN
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:670 9TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6249
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:707-826-8638
Practice Address - Street 1:1644 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-4342
Practice Address - Country:US
Practice Address - Phone:707-839-3068
Practice Address - Fax:707-839-3827
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT108363AM0700X
CA53231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0434367Medicaid
MT0434367Medicaid