Healthcare Provider Details

I. General information

NPI: 1669477378
Provider Name (Legal Business Name): ALLISON W ZELENAK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON C. WHITE PA-C

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 02/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 HENRY ST
GREENSBORO NC
27405-3633
US

IV. Provider business mailing address

PO BOX 13605
GREENSBORO NC
27415-3605
US

V. Phone/Fax

Practice location:
  • Phone: 336-621-3777
  • Fax: 336-621-8374
Mailing address:
  • Phone: 336-832-9943
  • Fax: 336-832-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number103693
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: