Healthcare Provider Details

I. General information

NPI: 1851986871
Provider Name (Legal Business Name): ALLISON R. HUPP APRN.CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 POPLAR ST NW
BOLIVAR OH
44612-9208
US

IV. Provider business mailing address

1303 CALIFORNIA AVE
LOUISVILLE OH
44641-8737
US

V. Phone/Fax

Practice location:
  • Phone: 133-066-3140
  • Fax:
Mailing address:
  • Phone: 330-693-5021
  • Fax: 330-693-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0028357
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: