Provider Demographics
NPI:1487786208
Name:ALLEN, EMMA D
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:D
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 1:171 CAMPBELL LN
Mailing Address - Street 2:
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447-9731
Mailing Address - Country:US
Mailing Address - Phone:775-463-3335
Mailing Address - Fax:
Practice Address - Street 1:171 CAMPBELL LN
Practice Address - Street 2:
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-9731
Practice Address - Country:US
Practice Address - Phone:775-463-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV102TCL-7291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory