Provider Demographics
NPI:1619207016
Name:ALLEN, LISA ANNE (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:ALLEN
Suffix:
Gender:F
Credentials: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 S PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-6318
Mailing Address - Country:US
Mailing Address - Phone:740-454-4822
Mailing Address - Fax:
Practice Address - Street 1:36 S PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-6318
Practice Address - Country:US
Practice Address - Phone:740-823-2451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN446043163W00000X
OHPN109854-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse