Provider Demographics
NPI:1619412822
Name:BEAULIEU, ALISON (DVM)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 HARRY L DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1119
Mailing Address - Country:US
Mailing Address - Phone:607-217-5202
Mailing Address - Fax:607-238-1751
Practice Address - Street 1:716 HARRY L DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1119
Practice Address - Country:US
Practice Address - Phone:607-217-5202
Practice Address - Fax:607-238-1751
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009398284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital