Provider Demographics
NPI:1780846345
Name:ALLEN, MICHELE C (NP)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:C
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 CHARWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2515
Mailing Address - Country:US
Mailing Address - Phone:636-947-9790
Mailing Address - Fax:636-947-9790
Practice Address - Street 1:1201 CHARWOOD ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2515
Practice Address - Country:US
Practice Address - Phone:636-947-9790
Practice Address - Fax:636-947-9790
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO072868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily