Provider Demographics
NPI:1255217634
Name:MCCONNELL, ALLISON RENEE (PA-C)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:RENEE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8207 ST JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-4615
Mailing Address - Country:US
Mailing Address - Phone:734-928-8542
Mailing Address - Fax:
Practice Address - Street 1:8207 ST JOHNS DR
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-4615
Practice Address - Country:US
Practice Address - Phone:734-928-8542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1235883363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant