Provider Demographics
NPI:1285642793
Name:ALLISON, DOREEN R (CRNP)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:R
Last Name:ALLISON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48120 HOMESTEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9688
Mailing Address - Country:US
Mailing Address - Phone:330-386-6642
Mailing Address - Fax:
Practice Address - Street 1:77 E MIDLOTHIAN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-2021
Practice Address - Country:US
Practice Address - Phone:330-788-2487
Practice Address - Fax:330-788-2487
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005645B363L00000X
OHRN197805363L00000X
OHCOA.05309363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S88836Medicare UPIN
031273Medicare PIN