Healthcare Provider Details

I. General information

NPI: 1629162565
Provider Name (Legal Business Name): LYNN M. ALLEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 CAMPUS PARK DR STE C
MONROE NC
28112-5284
US

IV. Provider business mailing address

1300 BAXTER ST STE 215
CHARLOTTE NC
28204-3053
US

V. Phone/Fax

Practice location:
  • Phone: 704-226-0366
  • Fax: 704-971-0035
Mailing address:
  • Phone: 704-332-0396
  • Fax: 704-971-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334998
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5006969
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: