Individual provider · NPI-1

Marissa Brianna Allen

Student in an Organized Health Care Education/Training Program · Charleston, SC

NPI number1013770395
StatusActive
Last updated in NPPESJan 31, 2024

Details

NPI
1013770395
Entity type
Individual (NPI-1)
Name
Mrs. Marissa Brianna Allen
Sex
Female
Sole proprietor
No
Enumeration date
Jan 31, 2024
Certification date
Jan 31, 2024
Last updated
Jan 31, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
390200000X Student in an Organized Health Care Education/Training Program––Yes
363A00000X Physician Assistant––

Practice location

8189 Little Sydneys Way
Charleston, SC 29406-8922

Phone 502-492-9929

Mailing address

8189 Little Sydneys Way
Charleston, SC 29406-8922

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