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General NPI Number Information
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NPI Number | 1568695179
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Entity Type | Individual
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Provider Name | ANGELA MICHELE ALLEN
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Gender | Female
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Dates
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Enumeration Date | 08/29/2009
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 3956 MOUNT ELLIOTT ST
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City | DETROIT
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State | MI
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Zip | 48207-1841
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Country | US
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Telephone | 313-925-4540
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Fax | 313-925-4604
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Provider Business Mailing Address
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Address Line | 3956 MOUNT ELLIOTT STREET
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City | DETROIT
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State | MI
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Zip | 48207-1841
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Country | US
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Telephone | 313-925-4540
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Fax | 313-925-4604
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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 | 4704198201
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License Number State | MI
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