Provider Demographics
NPI:1578128435
Name:MANNING, ALLISON (FNP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 VESTAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2020
Mailing Address - Country:US
Mailing Address - Phone:607-798-1452
Mailing Address - Fax:607-798-1792
Practice Address - Street 1:2517 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2020
Practice Address - Country:US
Practice Address - Phone:607-798-1452
Practice Address - Fax:607-798-1792
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1578128435Medicaid