MEDICARE: TRICIA DAYVONETTE ALLEN

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	172A00000X	Driver

General Provider Information

NPI Number	:	1326662636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRICIA DAYVONETTE ALLEN

Provider Business Mailing Address
First Line	:	706 2ND AVE
Second Line	:
City	:	LAWRENCEVILLE
State	:	VA
Zip	:	23868-1408
Country	:	US
Telephone Number	:	434-623-8593
Fax Number	:

Provider Business Practice Location Address
First Line	:	706 2ND AVE
Second Line	:
City	:	LAWRENCEVILLE
State	:	VA
Zip	:	23868-1408
Country	:	US
Telephone Number	:	434-623-8593
Fax Number	:

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

Provider Enumeration Date	:	06/02/2020
Last Update Date	:	07/27/2023

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Directions to “ TRICIA DAYVONETTE ALLEN ” Practice Location

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