Provider Demographics
NPI:1518687417
Name:ALLSOP, MARIANA (A-GNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARIANA
Middle Name:
Last Name:ALLSOP
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:MARIANA
Other - Middle Name:
Other - Last Name:GOLPHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:285 SUGARBUSH RD
Mailing Address - Street 2:
Mailing Address - City:HENRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18332-7175
Mailing Address - Country:US
Mailing Address - Phone:484-619-1631
Mailing Address - Fax:570-392-6360
Practice Address - Street 1:285 SUGARBUSH RD
Practice Address - Street 2:
Practice Address - City:HENRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:18332-7175
Practice Address - Country:US
Practice Address - Phone:484-619-1631
Practice Address - Fax:570-392-6360
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026201363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care