Healthcare Provider Details

I. General information

NPI: 1245565100
Provider Name (Legal Business Name): ALLISON NICOLE ALLREAD NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST SUITE 4140
DAYTON OH
45409-2722
US

IV. Provider business mailing address

3170 KETTERING BLVD BUILDING B 3RD FLOOR
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-4110
  • Fax:
Mailing address:
  • Phone: 937-991-3188
  • Fax: 937-223-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number10749-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: