MEDICARE: MRS. CAROLYN MICHELLE ALLEN CRNP-F

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R133461	MD

General Provider Information

NPI Number	:	1043514854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN MICHELLE ALLEN CRNP-F

Provider Business Mailing Address
First Line	:	5802 KING ARTHUR WAY
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-8905
Country	:	US
Telephone Number	:	301-464-7614
Fax Number	:

Provider Business Practice Location Address
First Line	:	5802 KING ARTHUR WAY
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-8905
Country	:	US
Telephone Number	:	301-464-7614
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2011
Last Update Date	:	01/08/2011

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