1922086271 NPI number — MRS. DIANE MARY ALLEN ANP

Table of content: MRS. DIANE MARY ALLEN ANP (NPI 1922086271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922086271 NPI number — MRS. DIANE MARY ALLEN ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
DIANE
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEGIN
Provider Other First Name:
DIANE
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922086271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2817 REILLY RD
Provider Second Line Business Mailing Address:
MCXC MED CARDIOLOGY
Provider Business Mailing Address City Name:
FORT BRAGG
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28310-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-907-7811
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2817 REILLY ROAD
Provider Second Line Business Practice Location Address:
WOMACK ARMY MEDICAL CENTER MCXC COD CREDENTIALS
Provider Business Practice Location Address City Name:
FORT BRAGG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-907-8922
Provider Business Practice Location Address Fax Number:
910-907-6069
Provider Enumeration Date:
01/06/2006

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: 363L00000X , with the licence number:  900300 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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