Provider Demographics
NPI:1679100234
Name:ALLEN, ANDREA L (RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 MILL STREAM DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1780
Mailing Address - Country:US
Mailing Address - Phone:559-572-4772
Mailing Address - Fax:
Practice Address - Street 1:1631 MILL STREAM DR
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1780
Practice Address - Country:US
Practice Address - Phone:559-572-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA648547163WA2000X, 163WI0500X, 163WL0100X, 163WM0102X, 163WN0003X, 163WX0002X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk