Provider Demographics
NPI:1811961790
Name:ALLEN, ANN GOODLOE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:GOODLOE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:102 BUSINESS WAY
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4593
Mailing Address - Country:US
Mailing Address - Phone:540-886-5721
Mailing Address - Fax:540-886-5776
Practice Address - Street 1:102 BUSINESS WAY
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4593
Practice Address - Country:US
Practice Address - Phone:540-886-5721
Practice Address - Fax:540-886-5776
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024038973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S07446Medicare UPIN