Healthcare Provider Details

I. General information

NPI: 1508625245
Provider Name (Legal Business Name): ANGELA LEE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 E 8TH AVE
HOMESTEAD PA
15120-1901
US

IV. Provider business mailing address

491 E 8TH AVE
HOMESTEAD PA
15120-1901
US

V. Phone/Fax

Practice location:
  • Phone: 412-464-2101
  • Fax: 412-464-2105
Mailing address:
  • Phone: 412-464-2101
  • Fax: 412-464-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN763515
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: