Provider Demographics
NPI:1811210685
Name:ALLEN, NELLIE C (LMT)
Entity Type:Individual
Prefix:MS
First Name:NELLIE
Middle Name:C
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11141/2 W. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-1014
Mailing Address - Country:US
Mailing Address - Phone:575-746-6119
Mailing Address - Fax:575-746-1718
Practice Address - Street 1:11141/2 W. MAIN ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88211-1014
Practice Address - Country:US
Practice Address - Phone:575-746-6119
Practice Address - Fax:575-746-1718
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1877173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist