Provider Demographics
NPI:1497420954
Name:ALLEN, IVERTA (NBC-HWC)
Entity Type:Individual
Prefix:MRS
First Name:IVERTA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12010 PHILOSOPHY WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5124
Mailing Address - Country:US
Mailing Address - Phone:419-297-3824
Mailing Address - Fax:
Practice Address - Street 1:12010 PHILOSOPHY WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5124
Practice Address - Country:US
Practice Address - Phone:419-297-3824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL