Provider Demographics
NPI:1164020392
Name:ALLEN, SAREE (FNP)
Entity Type:Individual
Prefix:
First Name:SAREE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E RICH BLVD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-5518
Mailing Address - Country:US
Mailing Address - Phone:252-333-1277
Mailing Address - Fax:
Practice Address - Street 1:135 E RICH BLVD
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-5518
Practice Address - Country:US
Practice Address - Phone:252-333-1277
Practice Address - Fax:252-333-1877
Is Sole Proprietor?:No
Enumeration Date:2020-10-10
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0024180668363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program