Provider Demographics
NPI:1932584281
Name:ALLEN, NICHOLE (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 HEARTLAND CIR
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9236
Mailing Address - Country:US
Mailing Address - Phone:419-512-2645
Mailing Address - Fax:
Practice Address - Street 1:163 HEARTLAND CIR
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:OH
Practice Address - Zip Code:44233-9236
Practice Address - Country:US
Practice Address - Phone:419-512-2645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL139292207ZP0102X
OH35.144231207ZP0102X
FLTRN21988207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology