1528254596 NPI number — MS. PAULA JEAN HANSEL ALLEN PA-C

Table of content: MS. PAULA JEAN HANSEL ALLEN PA-C (NPI 1528254596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528254596 NPI number — MS. PAULA JEAN HANSEL ALLEN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSEL ALLEN
Provider First Name:
PAULA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALLEN
Provider Other First Name:
PAULA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528254596
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
670 9TH ST STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARCATA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95521-6249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-826-8633
Provider Business Mailing Address Fax Number:
707-826-8638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1644 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINLEYVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95519-4342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-839-3068
Provider Business Practice Location Address Fax Number:
707-839-3827
Provider Enumeration Date:
09/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  108 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 53231 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0434367 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".