Healthcare Provider Details

I. General information

NPI: 1952292484
Provider Name (Legal Business Name): MARY ALLEN MSN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2025
Last Update Date: 07/12/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 E DISCOVERY PKWY
BLOOMINGTON IN
47408-9059
US

IV. Provider business mailing address

PO BOX 7106
BLOOMINGTON IN
47407-7106
US

V. Phone/Fax

Practice location:
  • Phone: 812-918-3574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number1947
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: