Provider Demographics
NPI:1902067135
Name:ALLEN, JENNIFER E (NP)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:E
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3820
Mailing Address - Country:US
Mailing Address - Phone:718-852-5252
Mailing Address - Fax:718-398-0975
Practice Address - Street 1:332 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3820
Practice Address - Country:US
Practice Address - Phone:718-852-5252
Practice Address - Fax:718-398-0975
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY597310163W00000X
NY306191363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse