Provider Demographics
NPI:1285726208
Name:ALLEN, DEBORA LOUISE (NURSE PRACTIITONER)
Entity type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:LOUISE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NURSE PRACTIITONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W 261ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1013
Mailing Address - Country:US
Mailing Address - Phone:917-751-4260
Mailing Address - Fax:
Practice Address - Street 1:650 W 261ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1013
Practice Address - Country:US
Practice Address - Phone:917-751-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302989-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1I 02149099Medicare UPIN