Provider Demographics
NPI:1669779658
Name:JURGAITIS, ALLISON R (NP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:R
Last Name:JURGAITIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:MARCHESI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:856-881-7495
Mailing Address - Fax:
Practice Address - Street 1:122 SILVER LAKE RD
Practice Address - Street 2:MIDDLETOWN HIGH SCHOOL
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1225
Practice Address - Country:US
Practice Address - Phone:302-378-5775
Practice Address - Fax:302-378-5760
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007315363LW0102X
DELG-0000700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health