Provider Demographics
NPI:1992192371
Name:ALLISON, VIANCA
Entity type:Individual
Prefix:
First Name:VIANCA
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 1:24696 N ELDA CT APT 140B
Mailing Address - Street 2:
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-2353
Mailing Address - Country:US
Mailing Address - Phone:313-469-5739
Mailing Address - Fax:
Practice Address - Street 1:24696 N ELDA CT APT 140B
Practice Address - Street 2:
Practice Address - City:HARRISON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48045-2353
Practice Address - Country:US
Practice Address - Phone:313-469-5739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other