Provider Demographics
NPI:1568043651
Name:FAGGIONATO, ALISON MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:MARIE
Last Name:FAGGIONATO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:MARIE
Other - Last Name:CARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1905 CLEVELAND RD W
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1200
Mailing Address - Country:US
Mailing Address - Phone:419-707-7775
Mailing Address - Fax:
Practice Address - Street 1:112 INDEPENDENCE WAY STE 110
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-9812
Practice Address - Country:US
Practice Address - Phone:419-483-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0028723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily