Provider Demographics
NPI:1174946453
Name:VISALLI, DAWN
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:VISALLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 TURIN ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-3314
Mailing Address - Country:US
Mailing Address - Phone:315-337-8400
Mailing Address - Fax:315-334-5139
Practice Address - Street 1:401 TURIN ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-3314
Practice Address - Country:US
Practice Address - Phone:315-337-8400
Practice Address - Fax:315-334-5139
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339552163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool