Provider Demographics
NPI:1083999106
Name:ALLEN, LYNN HOLLIS (CNM)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:HOLLIS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21750 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-5452
Mailing Address - Country:US
Mailing Address - Phone:814-333-2309
Mailing Address - Fax:
Practice Address - Street 1:126 CORNISH STREET
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:NY
Practice Address - Zip Code:14781-9791
Practice Address - Country:US
Practice Address - Phone:716-761-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28001463367A00000X
PAMW010238367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife