Provider Demographics
NPI:1104187863
Name:ALLEN, INDIA
Entity Type:Individual
Prefix:
First Name:INDIA
Middle Name:
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 1:6142 SURREY SQUARE LN
Mailing Address - Street 2:APT 203
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-2918
Mailing Address - Country:US
Mailing Address - Phone:202-520-9203
Mailing Address - Fax:
Practice Address - Street 1:6142 SURREY SQUARE LN
Practice Address - Street 2:APT 203
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-2918
Practice Address - Country:US
Practice Address - Phone:202-520-9203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2426105374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide