Healthcare Provider Details

I. General information

NPI: 1457588188
Provider Name (Legal Business Name): CARLINE A. ALLEN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2009
Last Update Date: 06/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 S PECOS RD STE 17
LAS VEGAS NV
89121-5025
US

IV. Provider business mailing address

10421 BADGER RAVINE ST
LAS VEGAS NV
89178-8035
US

V. Phone/Fax

Practice location:
  • Phone: 702-433-5368
  • Fax:
Mailing address:
  • Phone: 702-485-4489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN58003
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: