Provider Demographics
NPI:1366884777
Name:STREETER, ALLYN ANDERSON (FNP)
Entity type:Individual
Prefix:
First Name:ALLYN
Middle Name:ANDERSON
Last Name:STREETER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-1518
Mailing Address - Country:US
Mailing Address - Phone:508-748-2000
Mailing Address - Fax:508-291-8368
Practice Address - Street 1:66 SPRING ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-1518
Practice Address - Country:US
Practice Address - Phone:508-748-2000
Practice Address - Fax:508-291-8368
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN255078363LF0000X, 363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily