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Individual
LIA M ALLEN
Active
Individual
LIA M ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CAA
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
457
FL
367H00000X
Anesthesiologist Assistant
Primary
75000148A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1101684989
ANTHEM PTAN
IN
01
—
264430I59
MEDICARE PTAN
IN
01
—
Q00699782
RAILROAD PTAN
IN
Enumeration date
08/14/2018
Last updated
07/30/2025
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