Provider Demographics
NPI:1164623880
Name:FORD, ALLISON NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:NICOLE
Last Name:FORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:NICOLE
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:230 BEISER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7793
Mailing Address - Country:US
Mailing Address - Phone:302-735-1880
Mailing Address - Fax:302-735-1884
Practice Address - Street 1:230 BEISER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7793
Practice Address - Country:US
Practice Address - Phone:302-735-1880
Practice Address - Fax:302-735-1884
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant