=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689236234
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLISON MARIE SPINELLA APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2019
-----------------------------------------------------
Last Update Date | 02/11/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 YORK STREET FMB 130
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-688-4242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 EVERS DR
-----------------------------------------------------
City | WOLCOTT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06716-2506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-877-0623
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 7929
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 7929
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------