1477563922 NPI number — MS. PATRICIA JACKSON ALLEN APRN PNP

Table of content: MS. PATRICIA JACKSON ALLEN APRN PNP (NPI 1477563922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477563922 NPI number — MS. PATRICIA JACKSON ALLEN APRN PNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
PATRICIA
Provider Middle Name:
JACKSON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN PNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACKSON
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
LUDDER
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN MS PNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477563922
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 ACORN HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-737-2345
Provider Business Mailing Address Fax Number:
203-785-6455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
789 HOWARD AVE
Provider Second Line Business Practice Location Address:
YNHH PRIMARY CARE CENTER
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-737-2345
Provider Business Practice Location Address Fax Number:
203-785-6455
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  002773 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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