Provider Demographics
NPI:1154032613
Name:ALLEN, CONNIE LEE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:LEE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:MIDDLE POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45863-0326
Mailing Address - Country:US
Mailing Address - Phone:419-771-3213
Mailing Address - Fax:
Practice Address - Street 1:201 N ADAMS STR
Practice Address - Street 2:
Practice Address - City:MIDDLE POINT
Practice Address - State:OH
Practice Address - Zip Code:45863-4586
Practice Address - Country:US
Practice Address - Phone:419-771-3213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty