Provider Demographics
NPI:1316494974
Name:ALLISON, MARQUETTA
Entity type:Individual
Prefix:
First Name:MARQUETTA
Middle Name:
Last Name:ALLISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 BAKEWELL
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605
Mailing Address - Country:US
Mailing Address - Phone:567-225-8414
Mailing Address - Fax:419-698-4909
Practice Address - Street 1:2017 BAKEWELL ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-1203
Practice Address - Country:US
Practice Address - Phone:567-225-8414
Practice Address - Fax:419-698-4909
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363110231289E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH363110231289EOtherNURSE AIDE
OH0157530Medicare PIN