Provider Demographics
NPI:1659747178
Name:ALLEN, MARY MARGO (RN)
Entity Type:Individual
Prefix:
First Name:MARY MARGO
Middle Name:
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:PO BOX 6091
Mailing Address - Street 2:11 PEKING ST
Mailing Address - City:CHINA VILLAGE
Mailing Address - State:ME
Mailing Address - Zip Code:04926-0091
Mailing Address - Country:US
Mailing Address - Phone:207-968-2046
Mailing Address - Fax:
Practice Address - Street 1:11 PEKING ST.
Practice Address - Street 2:
Practice Address - City:CHINA VILLAGE
Practice Address - State:ME
Practice Address - Zip Code:04926-0091
Practice Address - Country:US
Practice Address - Phone:207-968-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER041129163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse