Provider Demographics
NPI:1477565786
Name:ALLEN, SUSAN NONE (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NONE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 W DICKMAN RD STE L
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4866
Mailing Address - Country:US
Mailing Address - Phone:269-966-1101
Mailing Address - Fax:269-966-1113
Practice Address - Street 1:2775 W DICKMAN RD STE L
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49015-4866
Practice Address - Country:US
Practice Address - Phone:269-966-1101
Practice Address - Fax:269-966-1113
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704117333163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health