Provider Demographics
NPI:1467987800
Name:MACK, ALLISON CATHERINE (APRN)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:CATHERINE
Last Name:MACK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:ALLISON
Other - Middle Name:CATHERINE
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3841
Mailing Address - Country:US
Mailing Address - Phone:802-557-5149
Mailing Address - Fax:
Practice Address - Street 1:62 TILLEY DR STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4407
Practice Address - Country:US
Practice Address - Phone:802-847-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0126269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily