Provider Demographics
NPI:1629662846
Name:ALLEN, NESHUNTA VANNELL (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NESHUNTA
Middle Name:VANNELL
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 SUGARLOAF PARKWAY
Mailing Address - Street 2:STE 1108 #2895
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043
Mailing Address - Country:US
Mailing Address - Phone:800-567-9926
Mailing Address - Fax:
Practice Address - Street 1:5415 SUGARLOAF PARKWAY
Practice Address - Street 2:STE 1108 #2895
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043
Practice Address - Country:US
Practice Address - Phone:800-567-9926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN077616251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPN077616OtherLPN LICENSE