Provider Demographics
NPI:1437675956
Name:VIVIAN, ALISON R (BC-FNP)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:R
Last Name:VIVIAN
Suffix:
Gender:F
Credentials:BC-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 E MAIN ST STE 209
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1445
Mailing Address - Country:US
Mailing Address - Phone:508-870-1800
Mailing Address - Fax:
Practice Address - Street 1:57 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1464
Practice Address - Country:US
Practice Address - Phone:508-870-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2306110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2306110Medicaid
MARN2306110Medicaid