Provider Demographics
NPI:1164686739
Name:ALLEN, GWENDOLYN SUE (RN)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:SUE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11691 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:HORTON
Mailing Address - State:KS
Mailing Address - Zip Code:66439-9160
Mailing Address - Country:US
Mailing Address - Phone:785-873-3161
Mailing Address - Fax:
Practice Address - Street 1:11691 ALLEN RD
Practice Address - Street 2:
Practice Address - City:HORTON
Practice Address - State:KS
Practice Address - Zip Code:66439-9160
Practice Address - Country:US
Practice Address - Phone:785-873-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-34584-122163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine