Provider Demographics
NPI:1952007189
Name:ALLEN, JADEN
Entity Type:Individual
Prefix:
First Name:JADEN
Middle Name:
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 1:3601 21ST ST SE APT 309
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-1381
Mailing Address - Country:US
Mailing Address - Phone:307-299-8103
Mailing Address - Fax:
Practice Address - Street 1:3601 21ST ST SE APT 309
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-1381
Practice Address - Country:US
Practice Address - Phone:307-299-8103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program