Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 431178 | NY |
NPI | 1033636709 |
---|---|
Provider Name | Allison Marie Provenzale |
First Address | Oakland, NJ 07436-3818 |
Second Address | Manhasset, NY 11030-3816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2017 |
Last Update Date | 24/08/2017 |