Individual
ALLISON MARIE ILLSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(774) 443-7552
(774) 441-6086
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN2281827
MA
363LA2100X
Acute Care Nurse Practitioner
RN2281827
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110108544A
—
MA
Enumeration date
10/13/2015
Last updated
11/10/2020
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