Provider Demographics
NPI:1285207605
Name:STADE PIMPL, ALLYSON (APRN, FNP, AGACNP)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:STADE PIMPL
Suffix:
Gender:F
Credentials:APRN, FNP, AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 INNOVATION DR STE 300
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2215
Mailing Address - Country:US
Mailing Address - Phone:775-329-6241
Mailing Address - Fax:775-329-4921
Practice Address - Street 1:635 INNOVATION DR STE 300
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2215
Practice Address - Country:US
Practice Address - Phone:775-329-6241
Practice Address - Fax:775-329-4921
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV842260363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner