Provider Demographics
NPI:1336114511
Name:ALLEN, DOLSIE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DOLSIE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:BUTTERMILK FALLS ROAD
Mailing Address - City:SHAWNEE ON DELAWARE
Mailing Address - State:PA
Mailing Address - Zip Code:18356-0244
Mailing Address - Country:US
Mailing Address - Phone:570-421-3900
Mailing Address - Fax:570-424-1549
Practice Address - Street 1:BUTTERMILK FALLS RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE-ON-DELAWARE
Practice Address - State:PA
Practice Address - Zip Code:18356-0244
Practice Address - Country:US
Practice Address - Phone:570-421-3900
Practice Address - Fax:570-424-1549
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP004145C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007575050001Medicaid
PA744447OtherBLUE SHIELD
PAS65252Medicare UPIN
PA020690K01Medicare ID - Type Unspecified