MEDICARE: MR. BENJAMIN B ALLEN RN, BSN, CNOR, RNFA

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	163WR0006X	Registered Nurse First Assistant	1-131521	AL

General Provider Information

NPI Number	:	1396596375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN B ALLEN RN, BSN, CNOR, RNFA

Provider Business Mailing Address
First Line	:	7710 BRADLEY RD
Second Line	:
City	:	DUNCANVILLE
State	:	AL
Zip	:	35456-1908
Country	:	US
Telephone Number	:	205-792-4443
Fax Number	:

Provider Business Practice Location Address
First Line	:	1847 COMMONS NORTH DR
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35406-3700
Country	:	US
Telephone Number	:	205-349-0049
Fax Number	:	659-734-2003

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

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	03/28/2024

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