Healthcare Provider Details

I. General information

NPI: 1689719460
Provider Name (Legal Business Name): ALISON LORI CARLSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BOSTON POST RD
ORANGE CT
06477-3235
US

IV. Provider business mailing address

119 TUTTLE ST
BRISTOL CT
06010-6857
US

V. Phone/Fax

Practice location:
  • Phone: 203-891-0655
  • Fax:
Mailing address:
  • Phone: 860-819-5974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number003096
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: