Provider Demographics
NPI:1144692047
Name:ALLEN, NAUDREY (LPN)
Entity type:Individual
Prefix:
First Name:NAUDREY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 SHOREFIELD RD.
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1822
Mailing Address - Country:US
Mailing Address - Phone:240-821-4331
Mailing Address - Fax:
Practice Address - Street 1:2102 SHOREFIELD RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-1822
Practice Address - Country:US
Practice Address - Phone:240-821-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0020402967164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse