Healthcare Provider Details

I. General information

NPI: 1801529953
Provider Name (Legal Business Name): ALLIE RAE HALSOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLIE RAE MCMILLAN PA-C

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 04/08/2024
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 OERSTED RD NE
RIO RANCHO NM
87144-6562
US

IV. Provider business mailing address

6510 OERSTED RD NE
RIO RANCHO NM
87144-6562
US

V. Phone/Fax

Practice location:
  • Phone: 505-610-1950
  • Fax:
Mailing address:
  • Phone: 505-610-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: