Provider Demographics
NPI:1760755870
Name:ALLEN, WENDY JANE (LPN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JANE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 MANILA AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1767
Mailing Address - Country:US
Mailing Address - Phone:646-269-4040
Mailing Address - Fax:
Practice Address - Street 1:524 MANILA AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1767
Practice Address - Country:US
Practice Address - Phone:646-269-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288226-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse