Provider Demographics
NPI:1518116623
Name:ALLEN, DARLENE JOYCE (CNM)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:JOYCE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:JOYCE
Other - Last Name:BOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:313-745-4525
Mailing Address - Fax:313-745-4399
Practice Address - Street 1:4201 ST ANTOINE
Practice Address - Street 2:STE 4C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-745-4399
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704134512176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P32150044Medicare PIN