Provider Demographics
NPI:1699117697
Name:DEVINE, ALLISON CHRISTINE (PA-C, ATC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:CHRISTINE
Last Name:DEVINE
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:CHRISTINE
Other - Last Name:MOEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, ATC
Mailing Address - Street 1:14 RESEARCH PL
Mailing Address - Street 2:
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 RESEARCH PL
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2412
Practice Address - Country:US
Practice Address - Phone:978-454-0706
Practice Address - Fax:978-970-0454
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6086363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant