Provider Demographics
NPI:1194346247
Name:ALLEN, DENETRI LAMESHA
Entity type:Individual
Prefix:
First Name:DENETRI
Middle Name:LAMESHA
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 1:3863 SULLIVAN AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63107-2002
Mailing Address - Country:US
Mailing Address - Phone:314-285-4387
Mailing Address - Fax:
Practice Address - Street 1:3863 SULLIVAN AVE FL 1
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63107-2002
Practice Address - Country:US
Practice Address - Phone:314-285-4387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health