Provider Demographics
NPI:1568291318
Name:MORDARSKI, ALLISON KATHERINE (PA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:KATHERINE
Last Name:MORDARSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 BERWYN DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-1152
Mailing Address - Country:US
Mailing Address - Phone:586-819-6147
Mailing Address - Fax:
Practice Address - Street 1:30060 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-5718
Practice Address - Country:US
Practice Address - Phone:586-207-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012585TMP24363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant