Healthcare Provider Details

I. General information

NPI: 1689062176
Provider Name (Legal Business Name): KRISTIN LAUER ALLISON FNP, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL SUITE 405
RALEIGH NC
27607-7513
US

IV. Provider business mailing address

4414 LAKE BOONE TRL SUITE 405
RALEIGH NC
27607-7513
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-8225
  • Fax:
Mailing address:
  • Phone: 919-876-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5007352
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: