Healthcare Provider Details

I. General information

NPI: 1275147167
Provider Name (Legal Business Name): ROSALYNN JOY ALLEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSALYNN JOY ALLEN

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/20/2020
Certification Date: 09/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1590
US

IV. Provider business mailing address

3412 CARRIAGE HILL CIR APT 104
RANDALLSTOWN MD
21133-6023
US

V. Phone/Fax

Practice location:
  • Phone: 601-274-1578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR121828
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberR121828
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: