Provider Demographics
NPI:1487124392
Name:STARK, ALLISON R (NP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:R
Last Name:STARK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:R
Other - Last Name:STEFFEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4433 S 70TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4275
Mailing Address - Country:US
Mailing Address - Phone:402-486-7075
Mailing Address - Fax:402-434-6047
Practice Address - Street 1:2300 S 16TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3704
Practice Address - Country:US
Practice Address - Phone:402-475-1011
Practice Address - Fax:402-481-4783
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE74308163W00000X
NE112700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024994601Medicaid
NE10024994600Medicaid