Provider Demographics
NPI:1326226309
Name:REDWINE, ALISON (NMD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:
Last Name:REDWINE
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4609
Mailing Address - Country:US
Mailing Address - Phone:602-538-6157
Mailing Address - Fax:928-525-1803
Practice Address - Street 1:105 E BIRCH AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4609
Practice Address - Country:US
Practice Address - Phone:602-538-6157
Practice Address - Fax:928-525-1803
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05-850175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath