Provider Demographics
NPI:1245827716
Name:ALLEN, ROBIN RENEE (INDEPENDENT PROVIDER)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:RENEE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 GREENE TREE PL
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-6424
Mailing Address - Country:US
Mailing Address - Phone:937-477-1446
Mailing Address - Fax:
Practice Address - Street 1:523 GREENE TREE PL
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-6424
Practice Address - Country:US
Practice Address - Phone:937-477-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0270229376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0270229Medicaid