Healthcare Provider Details

I. General information

NPI: 1699024760
Provider Name (Legal Business Name): ALISON B DELUCIA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON B DELUCIA

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E DUBLIN GRANVILLE RD
WORTHINGTON OH
43085-3192
US

IV. Provider business mailing address

5383 CARINA CT
HILLIARD OH
43026-9710
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-2850
  • Fax:
Mailing address:
  • Phone: 419-351-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0612571
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: