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NPI Code Detail

MEDICARE: NATHAN MARK ALLEN NP

MEDICARE: NATHAN MARK ALLEN NP
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
1363L00000XNurse Practitioner5014200NC

General Provider Information

NPI Number : 1558946475
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN MARK ALLEN NP
Provider Business Mailing Address
First Line : 1102 RIVER BIRCH WAY
Second Line :
City : MEBANE
State : NC
Zip : 27302-7826
Country : US
Telephone Number : 919-753-4340
Fax Number :
Provider Business Practice Location Address
First Line : 1234 HUFFMAN MILL RD
Second Line :
City : BURLINGTON
State : NC
Zip : 27215-8777
Country : US
Telephone Number : 336-538-1234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2021
Last Update Date : 03/11/2021

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