Provider Demographics
NPI:1952732869
Name:ALLEN, BRONWYN (CPNP)
Entity type:Individual
Prefix:
First Name:BRONWYN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:BRONWYN
Other - Middle Name:
Other - Last Name:BACKSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2330 JENA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-5906
Mailing Address - Country:US
Mailing Address - Phone:504-722-7687
Mailing Address - Fax:
Practice Address - Street 1:1315 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2406
Practice Address - Country:US
Practice Address - Phone:504-842-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382418364SP0200X
LAAP08498363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07455236Medicaid
LA2401700Medicaid
LA440171YH3UMedicare PIN