Provider Demographics
NPI:1649935107
Name:ALLISON, MICHELLE CATHERINE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CATHERINE
Last Name:ALLISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6082 MARTHA DR N
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:47001-9566
Mailing Address - Country:US
Mailing Address - Phone:513-708-3918
Mailing Address - Fax:
Practice Address - Street 1:6082 MARTHA DR N
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-9566
Practice Address - Country:US
Practice Address - Phone:513-708-3918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017074363LF0000X
OH0030402363LF0000X
IN2021036701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily