Provider Demographics
NPI:1245789775
Name:CARD, ALLISON (RN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:CARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 MAURA LN
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-2746
Mailing Address - Country:US
Mailing Address - Phone:518-280-1004
Mailing Address - Fax:
Practice Address - Street 1:1121 FOREST RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-1219
Practice Address - Country:US
Practice Address - Phone:518-370-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY676207163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01406986Medicaid