Provider Demographics
NPI:1467787309
Name:ALLEN, SUZETTE R (CNA)
Entity Type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 W GREEN TREE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-5325
Mailing Address - Country:US
Mailing Address - Phone:414-336-5639
Mailing Address - Fax:414-461-0199
Practice Address - Street 1:4740 W GREEN TREE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-5325
Practice Address - Country:US
Practice Address - Phone:414-336-5639
Practice Address - Fax:414-461-0199
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator