Provider Demographics
NPI:1972126142
Name:ALLISTON, AMY FAY (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:FAY
Last Name:ALLISTON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308B S MAIN ST STE 221
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1744
Mailing Address - Country:US
Mailing Address - Phone:434-808-9453
Mailing Address - Fax:
Practice Address - Street 1:308B S MAIN ST STE 221
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1744
Practice Address - Country:US
Practice Address - Phone:434-808-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL-88133163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant