Healthcare Provider Details

I. General information

NPI: 1801203963
Provider Name (Legal Business Name): ALISON ANN GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALISON ANN LAWLER RN

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DONNA DR
CALVERTON NY
11933-1342
US

IV. Provider business mailing address

50 DONNA DR
CALVERTON NY
11933-1342
US

V. Phone/Fax

Practice location:
  • Phone: 631-368-4153
  • Fax:
Mailing address:
  • Phone: 631-368-4153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-142028
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1-142028
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: