Healthcare Provider Details

I. General information

NPI: 1396441317
Provider Name (Legal Business Name): NICOLE ALLEN MS, ACSM-CEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SPRUNT ST
CHAPEL HILL NC
27517-7811
US

IV. Provider business mailing address

8910 CLAREYS FORREST LN APT 103
RALEIGH NC
27616-7935
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-2567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: