Basic Information
| Provider Information | |||||||||
| NPI: | 1649729757 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLAN | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4815 LIBERTY AVE | ||||||||
| Address2: | SUITE GR30 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152242156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125781116 | ||||||||
| FaxNumber: | 4126056396 | ||||||||
| Practice Location | |||||||||
| Address1: | 4815 LIBERTY AVE | ||||||||
| Address2: | SUITE GR30 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152242156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125781116 | ||||||||
| FaxNumber: | 4126056396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2016 | ||||||||
| LastUpdateDate: | 09/30/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA058429 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 030479 | 01 | PA | GROUP PTAN | OTHER |