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General NPI Number Information
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NPI Number | 1528330081
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Entity Type | Individual
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Provider Name | MARRYANNE ALLEN APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 3700 SOUTHERN BLVD STE 201
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City | DAYTON
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State | OH
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Zip | 45429-1265
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Country | US
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Telephone | 855-500-2873
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Fax | 937-281-3805
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Provider Business Mailing Address
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Address Line | 1512 W KIRBY PL
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City | SHREVEPORT
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State | LA
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Zip | 71103-3822
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Country | US
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Telephone | 318-626-0287
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 224457
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN.CNP.0038894
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 224457
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License Number State | LA
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