Provider Demographics
NPI:1053725341
Name:WILCZAK, ALLISON SUZANNE (LPN)
Entity type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:SUZANNE
Last Name:WILCZAK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:NY
Mailing Address - Zip Code:14005-9766
Mailing Address - Country:US
Mailing Address - Phone:716-580-2523
Mailing Address - Fax:
Practice Address - Street 1:601 WALNUT ST UPPR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-3129
Practice Address - Country:US
Practice Address - Phone:716-807-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312295-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse