Provider Demographics
NPI:1972003812
Name:ALLEN, MARQUETTA ROSCHELL
Entity Type:Individual
Prefix:
First Name:MARQUETTA
Middle Name:ROSCHELL
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARQUETTA
Other - Middle Name:ROSCHELL
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2709 ROYAL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-2903
Mailing Address - Country:US
Mailing Address - Phone:214-263-2176
Mailing Address - Fax:
Practice Address - Street 1:2709 ROYAL OAKS DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-2903
Practice Address - Country:US
Practice Address - Phone:214-263-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311589164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse