Provider Demographics
NPI:1902220452
Name:ALLEN, DOREEN L
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:L
Other - Last Name:ALLEN-FACEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN
Mailing Address - Street 1:20 SOUTH PARK PLACE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701
Mailing Address - Country:US
Mailing Address - Phone:631-375-6268
Mailing Address - Fax:
Practice Address - Street 1:20 S PARK PL
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2617
Practice Address - Country:US
Practice Address - Phone:631-375-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY582742163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse