Provider Demographics
NPI:1518297829
Name:ALLEN, MARY LOUISE (WHNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280148
Mailing Address - Street 2:NAVAL STATION
Mailing Address - City:MAYPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32228
Mailing Address - Country:US
Mailing Address - Phone:904-270-4444
Mailing Address - Fax:
Practice Address - Street 1:MASSEY AVE BLDG 2104
Practice Address - Street 2:
Practice Address - City:MAYPORT
Practice Address - State:FL
Practice Address - Zip Code:32228
Practice Address - Country:US
Practice Address - Phone:904-270-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9199564363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health