Healthcare Provider Details

I. General information

NPI: 1154032613
Provider Name (Legal Business Name): CONNIE LEE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N ADAMS STR
MIDDLE POINT OH
45863-4586
US

IV. Provider business mailing address

PO BOX 326
MIDDLE POINT OH
45863-0326
US

V. Phone/Fax

Practice location:
  • Phone: 419-771-3213
  • Fax:
Mailing address:
  • Phone: 419-771-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: