Basic Information
| Provider Information | |||||||||
| NPI: | 1902309826 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELUCA | ||||||||
| FirstName: | ALLYSSA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1281 PEONY ST NW | ||||||||
| Address2: | |||||||||
| City: | HARTVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446329004 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 855 W MAPLE ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | HARTVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446327601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308773616 | ||||||||
| FaxNumber: | 3308771783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2018 | ||||||||
| LastUpdateDate: | 11/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.022521 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.