Provider Demographics
NPI:1891505228
Name:ALLEN, LUCKY KOLLEH (CNA)
Entity type:Individual
Prefix:
First Name:LUCKY
Middle Name:KOLLEH
Last Name:ALLEN
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3272 9TH ST W APT F
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-7833
Mailing Address - Country:US
Mailing Address - Phone:701-977-0860
Mailing Address - Fax:
Practice Address - Street 1:3272 9TH ST W APT F
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-7833
Practice Address - Country:US
Practice Address - Phone:701-977-0860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND68216376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide