Provider Demographics
NPI:1316380637
Name:ALLEN, JUDITH EILEEN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:EILEEN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 S OWYHEE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-4643
Mailing Address - Country:US
Mailing Address - Phone:208-344-6099
Mailing Address - Fax:
Practice Address - Street 1:2419 W STATE ST STE 9
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-3167
Practice Address - Country:US
Practice Address - Phone:208-724-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-9828163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support