Provider Demographics
NPI:1861513046
Name:ALLEN, BREHON CHARLES JR (NP-C)
Entity type:Individual
Prefix:MR
First Name:BREHON
Middle Name:CHARLES
Last Name:ALLEN
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2979 VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2784
Mailing Address - Country:US
Mailing Address - Phone:563-332-8528
Mailing Address - Fax:563-332-9331
Practice Address - Street 1:2979 VICTORIA ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2784
Practice Address - Country:US
Practice Address - Phone:563-332-8528
Practice Address - Fax:563-332-9331
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAA135733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily