Provider Demographics
NPI:1124592274
Name:JOHNSON-ALLEN, DEON (APRN)
Entity Type:Individual
Prefix:
First Name:DEON
Middle Name:
Last Name:JOHNSON-ALLEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DEON
Other - Middle Name:
Other - Last Name:JOHNSON-ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:144C RED STONE HL
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2667
Mailing Address - Country:US
Mailing Address - Phone:718-938-5277
Mailing Address - Fax:
Practice Address - Street 1:88 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2509
Practice Address - Country:US
Practice Address - Phone:203-573-7265
Practice Address - Fax:203-573-7578
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7975363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1124592274Medicaid