Provider Demographics
NPI:1902328404
Name:DINALLO, AVERY (DNP, APN, FNP-C)
Entity type:Individual
Prefix:DR
First Name:AVERY
Middle Name:
Last Name:DINALLO
Suffix:
Gender:F
Credentials:DNP, APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4664 N PENNGROVE WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7442
Mailing Address - Country:US
Mailing Address - Phone:208-898-7467
Mailing Address - Fax:208-398-2120
Practice Address - Street 1:4664 N PENNGROVE WAY STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7442
Practice Address - Country:US
Practice Address - Phone:208-898-7467
Practice Address - Fax:208-398-2120
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00744300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily