Provider Demographics
NPI:1255680013
Name:ALLEN, CATHY JO (RN)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:JO
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-2927
Mailing Address - Country:US
Mailing Address - Phone:585-324-5925
Mailing Address - Fax:585-474-4463
Practice Address - Street 1:281 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-2927
Practice Address - Country:US
Practice Address - Phone:585-324-5925
Practice Address - Fax:585-474-4463
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY524186390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program