Provider Demographics
NPI:1669035721
Name:ALLEN, JEANETTE Q (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:Q
Last Name:ALLEN
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-2693
Mailing Address - Country:US
Mailing Address - Phone:414-795-7352
Mailing Address - Fax:
Practice Address - Street 1:2021 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2693
Practice Address - Country:US
Practice Address - Phone:414-795-7352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI229498163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse