Provider Demographics
NPI:1235714833
Name:ALLEN, ERICA NICOLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:NICOLE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:NICOLE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:170 BECKWITH RD
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:NY
Mailing Address - Zip Code:14871-9581
Mailing Address - Country:US
Mailing Address - Phone:607-207-5847
Mailing Address - Fax:
Practice Address - Street 1:170 BECKWITH RD
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:NY
Practice Address - Zip Code:14871-9581
Practice Address - Country:US
Practice Address - Phone:607-207-5847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333367164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse