Provider Demographics
NPI:1639800816
Name:ALLISON, MARIE SUSANNE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:SUSANNE
Last Name:ALLISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2436 JAKES RUN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:26570-8536
Mailing Address - Country:US
Mailing Address - Phone:301-247-7548
Mailing Address - Fax:
Practice Address - Street 1:2436 JAKES RUN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:WV
Practice Address - Zip Code:26570-8536
Practice Address - Country:US
Practice Address - Phone:301-247-7548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant