Deloris Ann Marie Allen, NP
Individual provider Active NPI Registered Nurse · Fort Wayne, IN
NPI 1225895618 · NPPES record last updated Mar 1, 2024
Key facts
- NPI
- 1225895618
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 28242855A (IN)
- Practice address
- 2200 Randallia Dr
Fort Wayne, IN 46805-4638 - Phone
- (260) 373-4000
- NPI assigned
- Mar 1, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241211002308 | IN | Practitioner - Nurse Practitioner | 7517493794 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PENDING | IN | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | PENDING | IN | |
| Registered Nurse | 163W00000X | 28242855A | IN | Yes |
Addresses
Primary practice location
2200 Randallia Dr
Fort Wayne, IN 46805-4638
Mailing address
2200 Randallia Dr
Fort Wayne, IN 46805-4638
Phone (260) 373-4000
Other providers in Fort Wayne, IN
- Allen County Retinal Surgeons, P.C.
- Allen County Wellness Center LLC
- Danielle R Allen
- Darian Allen
- David M. Allen
- Eli Bertram Allen
- Karissa Allen
- Krystal Allen
- Martella Allen
- Nicholas Allen
All providers in Fort Wayne, IN · Registered Nurse in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.