Provider Demographics
NPI:1750645735
Name:MAHER, ALLISON VALIQUETT (APRN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:VALIQUETT
Last Name:MAHER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3118 EAST 10TH STREET, SUITE A
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE,
Practice Address - State:IN
Practice Address - Zip Code:47130-3903
Practice Address - Country:US
Practice Address - Phone:812-282-6979
Practice Address - Fax:812-284-2798
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201182740Medicaid
KY7100202540Medicaid