Provider Demographics
NPI:1316448277
Name:WARD, ALLISON RAE (NP-C)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:RAE
Last Name:WARD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 NUCKOLS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9246
Mailing Address - Country:US
Mailing Address - Phone:314-492-2412
Mailing Address - Fax:
Practice Address - Street 1:10900 NUCKOLS RD STE 110
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-9246
Practice Address - Country:US
Practice Address - Phone:314-492-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041442062163W00000X
MO2007023581163W00000X
MO2017008073363L00000X
IL209016662363L00000X
NC5013863363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse