Provider Demographics
NPI:1366502700
Name:VALLEJO, ALLISON L (PNP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:L
Last Name:VALLEJO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8347
Mailing Address - Country:US
Mailing Address - Phone:928-783-0148
Mailing Address - Fax:928-783-7997
Practice Address - Street 1:1073 W 23RD ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8347
Practice Address - Country:US
Practice Address - Phone:928-783-0148
Practice Address - Fax:928-783-7997
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN124875163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ844094Medicare ID - Type UnspecifiedAHCCCS