Provider Demographics
NPI:1497591887
Name:PISKULIC, ALYSON EVE (STUDENT)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:EVE
Last Name:PISKULIC
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 GREYFIELD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3782
Mailing Address - Country:US
Mailing Address - Phone:314-691-8538
Mailing Address - Fax:
Practice Address - Street 1:4511 GREYFIELD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3782
Practice Address - Country:US
Practice Address - Phone:314-691-8538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program