Provider Demographics
NPI:1760032205
Name:ALLEN, TINA M (HIS)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 S 162ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-1410
Mailing Address - Country:US
Mailing Address - Phone:402-317-4186
Mailing Address - Fax:
Practice Address - Street 1:17650 WRIGHT ST STE 7
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2800
Practice Address - Country:US
Practice Address - Phone:402-502-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE808237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE808OtherHEARING INSTRUMENT SPECIALIST