Provider Demographics
NPI:1972076115
Name:ALLISON, NIKI RAE (RN)
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:RAE
Last Name:ALLISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9076
Mailing Address - Country:US
Mailing Address - Phone:505-599-8609
Mailing Address - Fax:505-599-8664
Practice Address - Street 1:1400 E 23RD ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-9076
Practice Address - Country:US
Practice Address - Phone:505-599-8609
Practice Address - Fax:505-599-8664
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-84403163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool