Provider Demographics
NPI:1124535778
Name:ROBERTS, ALLENE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:ALLENE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:70 W WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1868
Mailing Address - Country:US
Mailing Address - Phone:435-896-5451
Mailing Address - Fax:435-896-4353
Practice Address - Street 1:70 W WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1868
Practice Address - Country:US
Practice Address - Phone:435-896-5451
Practice Address - Fax:435-896-4353
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9074812-3102163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870629869Medicaid