Provider Demographics
NPI:1558770461
Name:ALLEN, ESSENCE MIRELL (MSNED RN)
Entity Type:Individual
Prefix:
First Name:ESSENCE
Middle Name:MIRELL
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSNED RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HARFORD DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2909
Mailing Address - Country:US
Mailing Address - Phone:631-681-2060
Mailing Address - Fax:
Practice Address - Street 1:36 HARFORD DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2909
Practice Address - Country:US
Practice Address - Phone:631-681-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316557164W00000X
NY826958-1163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No164W00000XNursing Service ProvidersLicensed Practical Nurse