Provider Demographics
NPI:1063410793
Name:ALLEN, SARA L (CRNP)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:L
Last Name:ALLEN
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Gender:F
Credentials:CRNP
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Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:SUITE 11511
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1320
Mailing Address - Country:US
Mailing Address - Phone:215-255-7822
Mailing Address - Fax:215-255-7825
Practice Address - Street 1:1427 VINE ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1031
Practice Address - Country:US
Practice Address - Phone:215-762-6018
Practice Address - Fax:215-246-5841
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-01-11
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Provider Licenses
StateLicense IDTaxonomies
PASP002024C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS46100Medicare UPIN