Provider Demographics
NPI:1154438919
Name:ALLEN, ONA CAROLYN (NP)
Entity type:Individual
Prefix:
First Name:ONA
Middle Name:CAROLYN
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 1:115 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:WA
Mailing Address - Zip Code:98932
Mailing Address - Country:US
Mailing Address - Phone:509-865-6450
Mailing Address - Fax:509-854-1919
Practice Address - Street 1:115 SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:WA
Practice Address - Zip Code:98932
Practice Address - Country:US
Practice Address - Phone:509-865-6450
Practice Address - Fax:509-854-1919
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR081047211N3363L00000X
WAAP30004237363L00000X
WARN00062564363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner