Provider Demographics
NPI:1225461221
Name:NICOLOSI, ALYSON (APRN)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:NICOLOSI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:
Other - Last Name:ADLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 PHOENIX AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-1418
Mailing Address - Country:US
Mailing Address - Phone:203-756-8021
Mailing Address - Fax:203-596-9038
Practice Address - Street 1:80 PHOENIX AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1418
Practice Address - Country:US
Practice Address - Phone:203-756-8021
Practice Address - Fax:203-596-9038
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005452363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008046690Medicaid
CT1225461221OtherANTHEM BCBS
CT223160873OtherHEALTHYCT
CT223160873OtherUNITED HEALTH CARE
CTD400104248Medicare PIN