Provider Demographics
NPI:1225249980
Name:ALLENSWORTH, MARIETTA FRANCES (LVN)
Entity Type:Individual
Prefix:MS
First Name:MARIETTA
Middle Name:FRANCES
Last Name:ALLENSWORTH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 CINDERELLA LN
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2511
Mailing Address - Country:US
Mailing Address - Phone:805-967-8126
Mailing Address - Fax:
Practice Address - Street 1:STUDENT HEALTH UNIVERSITY OF CA SANTA BARBARA
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-7002
Practice Address - Country:US
Practice Address - Phone:805-971-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 84882164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse