Provider Demographics
NPI:1013130111
Name:ALLTOP, MARY NICOLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:NICOLE
Last Name:ALLTOP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 VAQUERO CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-6755
Mailing Address - Country:US
Mailing Address - Phone:210-386-7753
Mailing Address - Fax:
Practice Address - Street 1:602 VAQUERO CT
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-6755
Practice Address - Country:US
Practice Address - Phone:210-386-7753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2010-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222011164X00000X
CA757233163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse