Provider Demographics
NPI:1730284001
Name:ALLISON, NANCY M (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:ALLISON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:M
Other - Last Name:PHALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:495 N MAIN ST
Mailing Address - Street 2:FARMINTON FAMILY PRACTICE
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1283
Mailing Address - Country:US
Mailing Address - Phone:585-393-3515
Mailing Address - Fax:585-393-3528
Practice Address - Street 1:495 N MAIN ST
Practice Address - Street 2:FARMINGTON FAMILY PRACTICE
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1283
Practice Address - Country:US
Practice Address - Phone:585-393-3515
Practice Address - Fax:585-393-3528
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355266Medicaid