Provider Demographics
NPI:1053419523
Name:MCINTYRE, ALLISON (NP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:MAPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278980
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 WHITE SPRUCE BLVD
Practice Address - Street 2:SUITE 400A
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1619
Practice Address - Country:US
Practice Address - Phone:585-427-9950
Practice Address - Fax:585-424-2788
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02804704Medicaid
NY02804704Medicaid