Provider Demographics
NPI:1558079491
Name:ALLEN, SUZANNE LAURA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:LAURA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PIERSON MILLER DR APT A11
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1035
Mailing Address - Country:US
Mailing Address - Phone:862-203-9933
Mailing Address - Fax:
Practice Address - Street 1:46 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1864
Practice Address - Country:US
Practice Address - Phone:888-926-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01395000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily