Provider Demographics
NPI:1518626027
Name:ALLISON, ALIAJA (LM, CPM)
Entity Type:Individual
Prefix:
First Name:ALIAJA
Middle Name:
Last Name:ALLISON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 21ST AVE S UPPR B
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-2774
Mailing Address - Country:US
Mailing Address - Phone:727-316-0295
Mailing Address - Fax:
Practice Address - Street 1:140 21ST AVE S UPPR B
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-2774
Practice Address - Country:US
Practice Address - Phone:727-316-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-12
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL425176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife