Provider Demographics
NPI:1407337413
Name:ALTING, ALLYSON MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:MARIE
Last Name:ALTING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ALLYSON
Other - Middle Name:MARIE
Other - Last Name:CECCHINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:366 SHREWSBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-4647
Mailing Address - Country:US
Mailing Address - Phone:508-595-2700
Mailing Address - Fax:774-221-5136
Practice Address - Street 1:366 SHREWSBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4647
Practice Address - Country:US
Practice Address - Phone:508-595-2700
Practice Address - Fax:774-221-5136
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2296778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110147381AMedicaid