Provider Demographics
NPI:1891441507
Name:ALLEN, TINA MARIE
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CROOKED CREEK RD.
Mailing Address - Street 2:
Mailing Address - City:PEACH CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25639
Mailing Address - Country:US
Mailing Address - Phone:304-896-4212
Mailing Address - Fax:
Practice Address - Street 1:215 CROOKED CREEK RD.
Practice Address - Street 2:
Practice Address - City:PEACH CREEK
Practice Address - State:WV
Practice Address - Zip Code:25639
Practice Address - Country:US
Practice Address - Phone:304-896-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant