Provider Demographics
NPI:1114567757
Name:ALLIS, ASHLEE SUZANNE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEE
Middle Name:SUZANNE
Last Name:ALLIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ASHLEE
Other - Middle Name:SUZANNE
Other - Last Name:BOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4815 LIBERTY AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-578-6808
Mailing Address - Fax:412-688-7517
Practice Address - Street 1:4815 LIBERTY AVE STE 115
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-578-6808
Practice Address - Fax:412-688-7517
Is Sole Proprietor?:No
Enumeration Date:2020-01-12
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF01200269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103763570Medicaid