Provider Demographics
NPI:1740662683
Name:FAVUZZA, ALLYSON KRISTEN (DNP, CRNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:KRISTEN
Last Name:FAVUZZA
Suffix:
Gender:F
Credentials:DNP, CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 DRINKER TPKE STE 13
Mailing Address - Street 2:
Mailing Address - City:COVINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-7948
Mailing Address - Country:US
Mailing Address - Phone:570-795-9795
Mailing Address - Fax:570-276-0195
Practice Address - Street 1:921 DRINKER TPKE STE 13
Practice Address - Street 2:
Practice Address - City:COVINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18444-7948
Practice Address - Country:US
Practice Address - Phone:570-795-9795
Practice Address - Fax:570-276-0195
Is Sole Proprietor?:No
Enumeration Date:2015-06-27
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339857363LF0000X
PASP015039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355931Medicaid
PA1030864040001Medicaid