Provider Demographics
NPI:1073627865
Name:ALLEN, CONNIE LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:LYNN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-9579
Mailing Address - Country:US
Mailing Address - Phone:317-856-2945
Mailing Address - Fax:317-856-5122
Practice Address - Street 1:5940 DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-9579
Practice Address - Country:US
Practice Address - Phone:317-856-2945
Practice Address - Fax:317-856-5122
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001780A363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN