Healthcare Provider Details

I. General information

NPI: 1477565786
Provider Name (Legal Business Name): SUSAN NONE ALLEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 W DICKMAN RD STE L
SPRINGFIELD MI
49015-4866
US

IV. Provider business mailing address

2775 W DICKMAN RD STE L
SPRINGFIELD MI
49015-4866
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-1101
  • Fax: 269-966-1113
Mailing address:
  • Phone: 269-966-1101
  • Fax: 269-966-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704117333
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: