Provider Demographics
NPI:1740230143
Name:ALLEN, ADA (CFNP)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:VA
Mailing Address - Zip Code:24557-4176
Mailing Address - Country:US
Mailing Address - Phone:434-656-2224
Mailing Address - Fax:434-656-3988
Practice Address - Street 1:305 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-4176
Practice Address - Country:US
Practice Address - Phone:434-656-2224
Practice Address - Fax:434-656-3988
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR127634363L00000X
VA0024166917363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010269041Medicaid
MD116914900Medicaid
VAMA0752534OtherDEA NUMBER