Provider Demographics
NPI:1639569874
Name:DELUCCA, ALLISON (PA-C, RDN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:DELUCCA
Suffix:
Gender:F
Credentials:PA-C, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 WILLOW BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-6059
Mailing Address - Country:US
Mailing Address - Phone:360-991-9416
Mailing Address - Fax:
Practice Address - Street 1:3480 WAKE FOREST RD STE 500
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:919-684-6437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-09359363A00000X
NCL005880133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-09359OtherNORTH CAROLINA MEDICAL BOARD: PA-C LICENSE
NCL005880OtherNORTH CAROLINA BOARD OF DIETETICS AND NUTRITION: NC RDN LICENSE
86015002OtherCOMMISSION ON DIETETIC REGISTRATION: REGISTERED DIETITIAN/NUTRITIONIST
1166067OtherNCCPA PA-C CERTIFICATION