Provider Demographics
NPI:1942737010
Name:ALLEN, CHANTELLE M (NP)
Entity Type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1378 S STATE ROAD 46
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-9787
Mailing Address - Country:US
Mailing Address - Phone:812-877-3310
Mailing Address - Fax:812-877-3005
Practice Address - Street 1:1378 S STATE ROAD 46 STE A
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-9787
Practice Address - Country:US
Practice Address - Phone:812-877-3310
Practice Address - Fax:812-877-3005
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28191736A207LP2900X, 363LF0000X
IN71007251A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine