Provider Demographics
NPI:1376574954
Name:ALLEN, KATHRYN JEAN (CRNA, ARNP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:JEAN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CRNA, ARNP
Other - Prefix:MRS
Other - First Name:KATHRYN
Other - Middle Name:JEAN
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA, ARNP
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2633
Mailing Address - Fax:319-356-2940
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2633
Practice Address - Fax:319-356-2940
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004680367500000X
IAD046537367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204213OtherMEDICARE GROUP
ILP00388162OtherRAILROAD MEDICARE
ILP00388162OtherRAILROAD MEDICARE
IAP00652444Medicare PIN
IAI0923128Medicare PIN
IL204213OtherMEDICARE GROUP