Provider Demographics
NPI:1821278029
Name:ALLISON, PAULA MARIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:MARIE
Last Name:ALLISON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23422 BURLINGAME AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-5718
Mailing Address - Country:US
Mailing Address - Phone:941-276-3454
Mailing Address - Fax:
Practice Address - Street 1:23422 BURLINGAME AVE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980
Practice Address - Country:US
Practice Address - Phone:941-276-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 4424133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6696ZMedicare PIN