1306488564 NPI number — ALYSON RAE MORAIS FNP

Table of content: ALYSON RAE MORAIS FNP (NPI 1306488564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306488564 NPI number — ALYSON RAE MORAIS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORAIS
Provider First Name:
ALYSON
Provider Middle Name:
RAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GWOZDZ
Provider Other First Name:
ALYSON
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306488564
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 OLD SOMERSET AVE, PO BOX 586
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH DIGHTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-824-7557
Provider Business Mailing Address Fax Number:
508-824-8296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 OLD SOMERSET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH DIGHTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-824-7557
Provider Business Practice Location Address Fax Number:
508-824-8296
Provider Enumeration Date:
10/09/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  2289179 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110158427A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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