Individual
TISA ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2999 PHILADELPHIA PIKE, CLAYMONT, DE 19703-2507
(302) 792-0700
(302) 792-0800
Mailing address
2999 PHILADELPHIA PIKE, CLAYMONT, DE 19703-2507
(302) 792-0700
(302) 792-0800
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN267228
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114079654
—
DE
Enumeration date
04/28/2022
Last updated
04/28/2022
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