Provider Demographics
NPI:1972845204
Name:ANCILLOTTI, ALAN D (NP)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:D
Last Name:ANCILLOTTI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 DOCTOR HENRY NORRIS DR
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-3165
Mailing Address - Country:US
Mailing Address - Phone:828-286-5575
Mailing Address - Fax:828-286-5574
Practice Address - Street 1:128 DOCTOR HENRY NORRIS DR
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-3165
Practice Address - Country:US
Practice Address - Phone:828-286-5575
Practice Address - Fax:828-286-5574
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily