Healthcare Provider Details

I. General information

NPI: 1619597572
Provider Name (Legal Business Name): ALISON NOEL BERKEYHEISER AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

61 CONCHESTER RD
GLEN MILLS PA
19342-1507
US

V. Phone/Fax

Practice location:
  • Phone: 916-703-5572
  • Fax:
Mailing address:
  • Phone: 484-757-0674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN650473
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95218467
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAG07190234
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95014457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: