Provider Demographics
NPI:1912552704
Name:CONGELIO, ALYVIA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALYVIA
Middle Name:MARIE
Last Name:CONGELIO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ALYVIA
Other - Middle Name:MARIE
Other - Last Name:ALLEGRETTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1044 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1006
Mailing Address - Country:US
Mailing Address - Phone:330-480-2040
Mailing Address - Fax:330-480-2071
Practice Address - Street 1:1044 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1006
Practice Address - Country:US
Practice Address - Phone:330-480-2040
Practice Address - Fax:330-480-2071
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025317363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0371983Medicaid