Healthcare Provider Details

I. General information

NPI: 1477623387
Provider Name (Legal Business Name): ESTHER LOUISE ALLEN D.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 N. TIFFIN
WEST TERRE HAUTE IN
47885
US

IV. Provider business mailing address

2150 NO. TIFFIN
WEST TERRE HAUTE IN
47885
US

V. Phone/Fax

Practice location:
  • Phone: 812-533-0045
  • Fax: 812-533-9935
Mailing address:
  • Phone: 812-533-0045
  • Fax: 812-533-9935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberNONE
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: