Provider Demographics
NPI:1952321655
Name:ALLEN, MARY PAT (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PAT
Last Name:ALLEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7376 NY ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:NY
Mailing Address - Zip Code:14489
Mailing Address - Country:US
Mailing Address - Phone:315-331-8039
Mailing Address - Fax:
Practice Address - Street 1:7376 ROUTE 31
Practice Address - Street 2:SUITE 1000
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489-9172
Practice Address - Country:US
Practice Address - Phone:315-331-8039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01951702Medicaid
NYRA5635Medicare PIN
NYDD5401Medicare PIN
NY01951702Medicaid