Provider Demographics
NPI:1316582638
Name:ALLEN, MINNIE CAROL
Entity Type:Individual
Prefix:
First Name:MINNIE
Middle Name:CAROL
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 FITCH ST SE APT 204
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5922
Mailing Address - Country:US
Mailing Address - Phone:202-553-6994
Mailing Address - Fax:
Practice Address - Street 1:5117 FITCH ST SE APT 204
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5922
Practice Address - Country:US
Practice Address - Phone:202-553-6994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant