Healthcare Provider Details

I. General information

NPI: 1336514801
Provider Name (Legal Business Name): ALISON A. DONLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W MCCREIGHT AVE STE 106
SPRINGFIELD OH
45504-1853
US

IV. Provider business mailing address

30 W MCCREIGHT AVE STE 106
SPRINGFIELD OH
45504-1853
US

V. Phone/Fax

Practice location:
  • Phone: 937-523-9820
  • Fax: 937-523-9829
Mailing address:
  • Phone: 937-523-9820
  • Fax: 937-523-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004536
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: