Provider Demographics
NPI:1477913820
Name:ALLEN, DEBORAH REGINA (CPNP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:REGINA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:REGINA
Other - Last Name:DARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1555 SELBY AVE # 2
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6340
Mailing Address - Country:US
Mailing Address - Phone:804-441-1833
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-365-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-28
Last Update Date:2016-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001078955163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse