Healthcare Provider Details

I. General information

NPI: 1659701837
Provider Name (Legal Business Name): RUTH LANORA ALLEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARKER DR STE 7
FLORENCE SC
29501-6059
US

IV. Provider business mailing address

3919 BRECKRIDGE CIR
FLORENCE SC
29505-5305
US

V. Phone/Fax

Practice location:
  • Phone: 866-877-2762
  • Fax: 866-992-7144
Mailing address:
  • Phone: 866-877-2762
  • Fax: 866-992-7144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number73067
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: