Provider Demographics
NPI:1518618578
Name:CLEGG, ALYSON (CRNP)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:CLEGG
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 1:12382 STATE ROUTE 3001
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:PA
Mailing Address - Zip Code:18801-7048
Mailing Address - Country:US
Mailing Address - Phone:570-244-5925
Mailing Address - Fax:
Practice Address - Street 1:12382 STATE ROUTE 3001
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801-7048
Practice Address - Country:US
Practice Address - Phone:570-244-5925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty