Provider Demographics
NPI:1477504389
Name:ALLEN, TERI (CERTIFIED NURSE MIDW)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CERTIFIED NURSE MIDW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HERRICK ST
Mailing Address - Street 2:STE 3002
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-927-4800
Mailing Address - Fax:978-232-5772
Practice Address - Street 1:83 HERRICK ST
Practice Address - Street 2:STE 3002
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-927-4800
Practice Address - Fax:978-232-5772
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
148614176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
RN0271Medicare ID - Type Unspecified
Q07946Medicare UPIN