Provider Demographics
NPI:1528497112
Name:ALLEN, CAROL LASEAN
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LASEAN
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 1:95 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2466
Mailing Address - Country:US
Mailing Address - Phone:704-690-1875
Mailing Address - Fax:
Practice Address - Street 1:95 DOGWOOD ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2466
Practice Address - Country:US
Practice Address - Phone:704-690-1875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health