Healthcare Provider Details

I. General information

NPI: 1376788042
Provider Name (Legal Business Name): JOHN M ALLEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 N 1000 W
LINTON IN
47441-5282
US

IV. Provider business mailing address

15343 W STATE ROAD 54
LINTON IN
47441-6226
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-2281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28180788A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28180788A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: