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NPI Code Detail

MEDICARE: EDNA ALLEN LPN

MEDICARE: EDNA ALLEN LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NurseLPN-23407NM

General Provider Information

NPI Number : 1184197089
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDNA ALLEN LPN
Provider Business Mailing Address
First Line : 112 MONROE ST NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87108-1247
Country : US
Telephone Number : 505-260-9917
Fax Number : 505-260-0754
Provider Business Practice Location Address
First Line : 112 MONROE ST NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87108-1247
Country : US
Telephone Number : 505-260-9917
Fax Number : 505-260-0754
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2019
Last Update Date : 02/05/2021

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