MEDICARE: ALLISON GRACE TREVINO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601010074	MI

General Provider Information

NPI Number	:	1306444187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON GRACE TREVINO

Provider Business Mailing Address
First Line	:	6741 FULTON ST E
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-9502
Country	:	US
Telephone Number	:	616-320-5330
Fax Number	:

Provider Business Practice Location Address
First Line	:	6741 FULTON ST E
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-9502
Country	:	US
Telephone Number	:	616-320-5330
Fax Number	:	616-320-5331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	12/04/2025

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Directions to “ ALLISON GRACE TREVINO ” Practice Location

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