Basic Information
Provider Information
NPI: 1275924987
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALIOTTA
FirstName: JENNIFER
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3104 BLUE LAKE DR
Address2: SUITE 110
City: VESTAVIA
State: AL
PostalCode: 352432345
CountryCode: US
TelephoneNumber: 2057833144
FaxNumber:  
Practice Location
Address1: 1000 1ST ST N
Address2:  
City: ALABASTER
State: AL
PostalCode: 350078703
CountryCode: US
TelephoneNumber: 2057833144
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/17/2015
LastUpdateDate: 10/01/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X1-128546ALY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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