Provider Demographics
NPI:1700329182
Name:ALLEN, CHAD E
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:E
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 LOCUST LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-9185
Mailing Address - Country:US
Mailing Address - Phone:740-605-0024
Mailing Address - Fax:
Practice Address - Street 1:905 LOCUST LAKE CIR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-9185
Practice Address - Country:US
Practice Address - Phone:740-605-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.123005164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse