Provider Demographics
NPI:1891191854
Name:PITRE, ALLAN ROBERT II (LPN)
Entity Type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:ROBERT
Last Name:PITRE
Suffix:II
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20881 SW QUINTESSA CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-5480
Mailing Address - Country:US
Mailing Address - Phone:616-304-1921
Mailing Address - Fax:
Practice Address - Street 1:20881 SW QUINTESSA CT
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97078-5480
Practice Address - Country:US
Practice Address - Phone:616-304-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2015-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703083813164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse