Provider Demographics
NPI:1265751564
Name:WILEY, ALLISON J (LPN)
Entity type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:J
Last Name:WILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1906
Mailing Address - Country:US
Mailing Address - Phone:607-244-4985
Mailing Address - Fax:
Practice Address - Street 1:10 DIAMOND ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1906
Practice Address - Country:US
Practice Address - Phone:607-371-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281862-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse