Provider Demographics
NPI:1063753812
Name:CALE, ALLISON GILLMAN (NP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:GILLMAN
Last Name:CALE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:NICOLE
Other - Last Name:GILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2855 DENBIGH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:GRAFTON
Practice Address - State:VA
Practice Address - Zip Code:23692-6501
Practice Address - Country:US
Practice Address - Phone:757-968-5700
Practice Address - Fax:757-968-5717
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063753812Medicaid
VA1063753812Medicaid
VAVV9391AMedicare PIN