Basic Information
Provider Information
NPI: 1366689887
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOOLLEY
FirstName: ALLISON
MiddleName: D
NamePrefix: MRS.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CARLISLE
OtherFirstName: ALLISON
OtherMiddleName: D
OtherNamePrefix: MS.
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 235022
Address2:  
City: MONTGOMERY
State: AL
PostalCode: 361235022
CountryCode: US
TelephoneNumber: 3343966930
FaxNumber: 3344811200
Practice Location
Address1: 315 W HICKORY ST
Address2:  
City: SYLACAUGA
State: AL
PostalCode: 351502913
CountryCode: US
TelephoneNumber: 2562495000
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/21/2009
LastUpdateDate: 01/21/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X1-100094ALY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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