Healthcare Provider Details

I. General information

NPI: 1992192371
Provider Name (Legal Business Name): VIANCA ALLISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24696 N ELDA CT APT 140B
HARRISON TOWNSHIP MI
48045-2353
US

IV. Provider business mailing address

24696 N ELDA CT APT 140B
HARRISON TOWNSHIP MI
48045-2353
US

V. Phone/Fax

Practice location:
  • Phone: 313-469-5739
  • Fax:
Mailing address:
  • Phone: 313-469-5739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: