Provider Demographics
NPI:1023124138
Name:ALLEN, NANCY JOANN (MS RD)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JOANN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11183 N 100 W
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47974-8057
Mailing Address - Country:US
Mailing Address - Phone:765-793-2366
Mailing Address - Fax:
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5100
Practice Address - Country:US
Practice Address - Phone:217-554-5728
Practice Address - Fax:217-554-4828
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered