Provider Demographics
NPI:1467737056
Name:ALLEN, WILLIAM MELVIN JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MELVIN
Last Name:ALLEN
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W NORTH ST
Mailing Address - Street 2:P.O. BOX 97
Mailing Address - City:WEST MANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45382-5049
Mailing Address - Country:US
Mailing Address - Phone:937-336-6876
Mailing Address - Fax:
Practice Address - Street 1:202 W NORTH ST
Practice Address - Street 2:
Practice Address - City:WEST MANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45382-5049
Practice Address - Country:US
Practice Address - Phone:937-336-6876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27067019A164W00000X
OHPN107462164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse