Healthcare Provider Details

I. General information

NPI: 1497533228
Provider Name (Legal Business Name): SHIRLEY MICHELE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 E ST SE
WASHINGTON DC
20003-2593
US

IV. Provider business mailing address

1905 E ST SE
WASHINGTON DC
20003-2593
US

V. Phone/Fax

Practice location:
  • Phone: 202-673-9319
  • Fax:
Mailing address:
  • Phone: 202-740-2155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN964436
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: