Provider Demographics
NPI:1093380347
Name:ALLEN, BERTHA M
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:M
Last Name:ALLEN
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 1:702 NORTHRIDGE DR APT 16
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9030
Mailing Address - Country:US
Mailing Address - Phone:304-992-4831
Mailing Address - Fax:
Practice Address - Street 1:702 NORTHRIDGE DR APT 16
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9030
Practice Address - Country:US
Practice Address - Phone:304-992-4831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant