Provider Demographics
NPI:1992042691
Name:ALLEN, HEATHER
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
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 1:327 UNION ST
Mailing Address - Street 2:APT E-25
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3770
Mailing Address - Country:US
Mailing Address - Phone:740-348-5924
Mailing Address - Fax:
Practice Address - Street 1:327 UNION ST
Practice Address - Street 2:APT E-25
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3770
Practice Address - Country:US
Practice Address - Phone:740-348-5924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN144453MIV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse