Provider Demographics
NPI:1386265395
Name:FANELLI, ALLISON MARIE (RN BSN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:FANELLI
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3363 COUNTY RD E
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53178-9669
Mailing Address - Country:US
Mailing Address - Phone:414-651-4843
Mailing Address - Fax:
Practice Address - Street 1:N3363 COUNTY RD E
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:WI
Practice Address - Zip Code:53178-9669
Practice Address - Country:US
Practice Address - Phone:414-651-4843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI200555163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse