Provider Demographics
NPI:1700938941
Name:ALLEN, DIANE L (NP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4500 SUNNY ISLE
Mailing Address - Street 2:1-2-3
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4493
Mailing Address - Country:US
Mailing Address - Phone:340-692-2510
Mailing Address - Fax:340-692-0344
Practice Address - Street 1:4500 SUNNY ISLE
Practice Address - Street 2:1-2-3
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4493
Practice Address - Country:US
Practice Address - Phone:340-692-2510
Practice Address - Fax:340-692-0344
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VIAP11815P363LW0102X
CANP7585363LW0102X
CARN335545163W00000X
VI11815163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ69318Medicare UPIN
CAWNP7585AMedicare ID - Type UnspecifiedMEDICARE