Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 71004980A | IN |
NPI | 1003222928 |
---|---|
Provider Name | Mrs. Maureen Patrice Mcgoff Allen |
First Address | Indianapolis, IN 46220-1826 |
Second Address | Cleveland, OH 44195-2744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2014 |
Last Update Date | 17/03/2018 |