Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 034032 | CT |
N | 207YS0123X | Facial Plastic Surgeon | 034032 | CT |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 034032 | CT |
NPI | 1588690374 |
---|---|
Provider Name | Dr. Jerilyn S Allen |
First Address | Willimantic, CT 06226-2122 |
Second Address | Willimantic, CT 06226-2122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 22/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001340322 | (05) | CT |
G47429 | (02) |