MEDICARE: MS. SARA L. ALLEN CRNP

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	363L00000X	Nurse Practitioner	SP002024C	PA

General Provider Information

NPI Number	:	1063410793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARA L. ALLEN CRNP

Provider Business Mailing Address
First Line	:	1601 CHERRY ST
Second Line	:	SUITE 11511
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1320
Country	:	US
Telephone Number	:	215-255-7822
Fax Number	:	215-255-7825

Provider Business Practice Location Address
First Line	:	1427 VINE ST
Second Line	:	5TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-1031
Country	:	US
Telephone Number	:	215-762-6018
Fax Number	:	215-246-5841

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/11/2019

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