Provider Demographics
NPI:1588060347
Name:ALLEN, CHERYL LYN (LPN)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LYN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DEARFIELD CT
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9012
Mailing Address - Country:US
Mailing Address - Phone:720-448-6644
Mailing Address - Fax:
Practice Address - Street 1:15 DEARFIELD CT
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-9012
Practice Address - Country:US
Practice Address - Phone:720-448-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309894164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse