Mary Chanel Allen

Key facts

NPI

1003659137

Entity type

Individual (NPI type 1)

Primary specialty

Licensed Vocational Nurse 164X00000X

License

LVN684277 (CA)

Practice address

14139 Bucher Ave
Sylmar, CA 91342-1442

Phone

(310) 221-6336

NPI assigned

Jun 17, 2024

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 17, 2024.

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1003659137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14139 BUCHER AVE",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913421442",
            "telephone_number": "310-221-6336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14139 BUCHER AVE",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913421442",
            "telephone_number": "310-221-6336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "MARY",
        "middle_name": "CHANEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-17",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "LVN684277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Sylmar, CA · Licensed Vocational Nurse in California