Provider Demographics
NPI:1619596707
Name:ALLEN, ADRIAN LEONDRA
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:LEONDRA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 S. HAZELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509
Mailing Address - Country:US
Mailing Address - Phone:330-519-5286
Mailing Address - Fax:
Practice Address - Street 1:34 S. HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509
Practice Address - Country:US
Practice Address - Phone:330-519-5286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant