Healthcare Provider Details

I. General information

NPI: 1275845406
Provider Name (Legal Business Name): ALLISON DENISE REXRODE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON DENISE AMANN

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12500 WILLOWBROOK RD
CUMBERLAND MD
21502-6393
US

IV. Provider business mailing address

54 MOUNT VISTA DR
NEW CREEK WV
26743-8758
US

V. Phone/Fax

Practice location:
  • Phone: 240-964-8740
  • Fax: 240-964-8741
Mailing address:
  • Phone: 304-813-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR176923
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: