Provider Demographics
NPI:1326662636
Name:ALLEN, TRICIA DAYVONETTE
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:DAYVONETTE
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 1:706 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-1408
Mailing Address - Country:US
Mailing Address - Phone:434-623-8593
Mailing Address - Fax:
Practice Address - Street 1:706 2ND AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868-1408
Practice Address - Country:US
Practice Address - Phone:434-623-8593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver