Provider Demographics
NPI:1700164514
Name:ALLEN, CASEY LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:LYNN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPN
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 222
Mailing Address - Street 2:
Mailing Address - City:RICHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13681-0222
Mailing Address - Country:US
Mailing Address - Phone:315-287-4906
Mailing Address - Fax:
Practice Address - Street 1:9 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:RICHVILLE
Practice Address - State:NY
Practice Address - Zip Code:13681
Practice Address - Country:US
Practice Address - Phone:315-287-4906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286012164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse