Provider Demographics
NPI:1578806105
Name:ELLISON, ALISA SUE (FNPC)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:SUE
Last Name:ELLISON
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:MRS
Other - First Name:ALISA
Other - Middle Name:SUE
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNPC
Mailing Address - Street 1:3547 TRUE RD.
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951
Mailing Address - Country:US
Mailing Address - Phone:304-716-1440
Mailing Address - Fax:304-466-2513
Practice Address - Street 1:197 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-2540
Practice Address - Country:US
Practice Address - Phone:304-466-2501
Practice Address - Fax:304-466-2513
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV80451363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care