Basic Information
Provider Information
NPI: 1790769636
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARKER
FirstName: ALISON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 104 PORTER DR
Address2:  
City: MIDDLEBURY
State: VT
PostalCode: 057538527
CountryCode: US
TelephoneNumber: 8023888808
FaxNumber: 8023888322
Practice Location
Address1: 82 CATAMOUNT PARK
Address2:  
City: MIDDLEBURY
State: VT
PostalCode: 057531292
CountryCode: US
TelephoneNumber: 8023887185
FaxNumber: 8023883445
Other Information
ProviderEnumerationDate: 12/05/2005
LastUpdateDate: 05/24/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X1010015322VTY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
100954605VT MEDICAID


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