Healthcare Provider Details

I. General information

NPI: 1235762964
Provider Name (Legal Business Name): ALLISON DANIELLE ERNEST PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 BREMO RD
RICHMOND VA
23226-2438
US

IV. Provider business mailing address

2905 RIDGEWOOD PARK CT
GLEN ALLEN VA
23060-2130
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-1881
  • Fax:
Mailing address:
  • Phone: 804-822-2197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024178897
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: