Provider Demographics
NPI:1366084675
Name:ALLEN, JENNA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
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 1:402 4TH ST
Mailing Address - Street 2:APT C1
Mailing Address - City:ROLFE
Mailing Address - State:IA
Mailing Address - Zip Code:50581
Mailing Address - Country:US
Mailing Address - Phone:515-368-2737
Mailing Address - Fax:
Practice Address - Street 1:705 CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:ROLFE
Practice Address - State:IA
Practice Address - Zip Code:50581
Practice Address - Country:US
Practice Address - Phone:515-368-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider