Provider Demographics
NPI:1477825347
Name:BRIMMER, ALLISHA ROSE (RN, LPN)
Entity Type:Individual
Prefix:MS
First Name:ALLISHA
Middle Name:ROSE
Last Name:BRIMMER
Suffix:
Gender:F
Credentials:RN, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17693 COUNTY ROUTE 76
Mailing Address - Street 2:
Mailing Address - City:ADAMS CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13606-2141
Mailing Address - Country:US
Mailing Address - Phone:315-506-3185
Mailing Address - Fax:
Practice Address - Street 1:17693 COUNTY ROUTE 76
Practice Address - Street 2:
Practice Address - City:ADAMS CENTER
Practice Address - State:NY
Practice Address - Zip Code:13606-2141
Practice Address - Country:US
Practice Address - Phone:315-506-3185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308552-1164W00000X
NY827014-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03419945Medicaid