Provider Demographics
NPI:1639656762
Name:ALLEN, ASHLEY LATOYA
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LATOYA
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 1:17 ARTHURIAN WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-1155
Mailing Address - Country:US
Mailing Address - Phone:585-317-6587
Mailing Address - Fax:
Practice Address - Street 1:17 ARTHURIAN WAY
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514-1155
Practice Address - Country:US
Practice Address - Phone:585-317-6587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332066164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse