Provider Demographics
NPI:1194285353
Name:WALDECKER, ALISON ROSE (RN)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:ROSE
Last Name:WALDECKER
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:1404 ASHMOOR LN
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9926
Mailing Address - Country:US
Mailing Address - Phone:616-460-1569
Mailing Address - Fax:
Practice Address - Street 1:4100 PARK FOREST DR STE 210
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7306
Practice Address - Country:US
Practice Address - Phone:231-935-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC291373163W00000X
MI4704299424163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse