Provider Demographics
NPI:1477183614
Name:DEWEESE, ALISON JAIDE (LPN)
Entity type:Individual
Prefix:MS
First Name:ALISON
Middle Name:JAIDE
Last Name:DEWEESE
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 1:711 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MULLENS
Mailing Address - State:WV
Mailing Address - Zip Code:25882-1221
Mailing Address - Country:US
Mailing Address - Phone:304-923-9523
Mailing Address - Fax:
Practice Address - Street 1:711 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MULLENS
Practice Address - State:WV
Practice Address - Zip Code:25882-1221
Practice Address - Country:US
Practice Address - Phone:304-923-9523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV38517164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse