Healthcare Provider Details

I. General information

NPI: 1285642793
Provider Name (Legal Business Name): DOREEN R ALLISON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 E MIDLOTHIAN BLVD
YOUNGSTOWN OH
44507-2021
US

IV. Provider business mailing address

48120 HOMESTEAD BLVD
EAST LIVERPOOL OH
43920-9688
US

V. Phone/Fax

Practice location:
  • Phone: 330-788-2487
  • Fax: 330-788-2487
Mailing address:
  • Phone: 330-386-6642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTP005645B
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN197805
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.05309
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: