Provider Demographics
NPI:1619682200
Name:ALLEN, ROBERT A (RN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CORPORATE DR STE D
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3124
Mailing Address - Country:US
Mailing Address - Phone:920-356-9415
Mailing Address - Fax:920-356-9477
Practice Address - Street 1:215 CORPORATE DR STE D
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3124
Practice Address - Country:US
Practice Address - Phone:920-579-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI197391-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse