Provider Demographics
NPI:1265580401
Name:IBANEZ, ALISON CRISS
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:CRISS
Last Name:IBANEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3100
Mailing Address - Country:US
Mailing Address - Phone:757-252-0590
Mailing Address - Fax:757-425-7180
Practice Address - Street 1:4439 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3100
Practice Address - Country:US
Practice Address - Phone:757-252-0590
Practice Address - Fax:757-425-7180
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001179524163W00000X
VA0024167759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse