MEDICARE: BRENDA J ALLEN RNCNP

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	363LW0102X	Women's Health Nurse Practitioner	341015	CA

General Provider Information

NPI Number	:	1295941623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA J ALLEN RNCNP

Provider Business Mailing Address
First Line	:	8552 GOLDEN RIDGE RD
Second Line	:
City	:	LAKESIDE
State	:	CA
Zip	:	92040-5632
Country	:	US
Telephone Number	:	619-561-2506
Fax Number	:

Provider Business Practice Location Address
First Line	:	4474 EL CAJON BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4312
Country	:	US
Telephone Number	:	619-283-6281
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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