Provider Demographics
NPI:1487893673
Name:ALLEN, JANNA PAULINE (LMP)
Entity type:Individual
Prefix:MS
First Name:JANNA
Middle Name:PAULINE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:JANNA
Other - Middle Name:PAULINE
Other - Last Name:CARRINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 1370
Mailing Address - Street 2:
Mailing Address - City:MCKENNA
Mailing Address - State:WA
Mailing Address - Zip Code:98558
Mailing Address - Country:US
Mailing Address - Phone:360-400-2002
Mailing Address - Fax:360-400-2004
Practice Address - Street 1:9111 346TH ST S.
Practice Address - Street 2:STE 3
Practice Address - City:ROY
Practice Address - State:WA
Practice Address - Zip Code:98580
Practice Address - Country:US
Practice Address - Phone:360-400-2002
Practice Address - Fax:360-400-2004
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60058237225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist