Basic Information
Provider Information
NPI: 1942494992
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLEN
FirstName: CHRISTINA
MiddleName: L
NamePrefix: MS.
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 711 TROY SCHENECTADY RD STE 203
Address2:  
City: LATHAM
State: NY
PostalCode: 121102461
CountryCode: US
TelephoneNumber: 5187823700
FaxNumber: 5187823799
Practice Location
Address1: 2125 RIVER RD STE 303
Address2:  
City: SCHENECTADY
State: NY
PostalCode: 123091135
CountryCode: US
TelephoneNumber: 5188312500
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/04/2007
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X335266NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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