Healthcare Provider Details

I. General information

NPI: 1164543815
Provider Name (Legal Business Name): MONIQUE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 E LAMAR BLVD
ARLINGTON TX
76011-3504
US

IV. Provider business mailing address

813 E LAMAR BLVD
ARLINGTON TX
76011-3504
US

V. Phone/Fax

Practice location:
  • Phone: 817-303-5893
  • Fax: 817-303-5953
Mailing address:
  • Phone: 817-303-5893
  • Fax: 817-303-5953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80210
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: