Provider Demographics
NPI:1194373084
Name:ALLEN, VIVIAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1492 S ERIE HWY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-4048
Mailing Address - Country:US
Mailing Address - Phone:513-795-6890
Mailing Address - Fax:513-795-7422
Practice Address - Street 1:1492 S ERIE HWY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4048
Practice Address - Country:US
Practice Address - Phone:513-795-6890
Practice Address - Fax:513-795-7422
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily