Provider Demographics
NPI:1104396803
Name:CLAYSHULTE, ALISON (NC)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:CLAYSHULTE
Suffix:
Gender:F
Credentials:NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3446 MT DIABLO BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3912
Mailing Address - Country:US
Mailing Address - Phone:925-280-4442
Mailing Address - Fax:
Practice Address - Street 1:3446 MT DIABLO BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3912
Practice Address - Country:US
Practice Address - Phone:925-280-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator