Healthcare Provider Details

I. General information

NPI: 1033014113
Provider Name (Legal Business Name): ALLYSON A. NIEMUTH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLYSON BLENIS

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 TAPESTRY CT
LIVERMORE CA
94550-8256
US

IV. Provider business mailing address

2470 TAPESTRY CT
LIVERMORE CA
94550-8256
US

V. Phone/Fax

Practice location:
  • Phone: 510-468-4227
  • Fax:
Mailing address:
  • Phone: 510-468-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number826973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: