Provider Demographics
NPI:1477275923
Name:ROTH, ALLISON LEIGH (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:LEIGH
Last Name:ROTH
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-4915
Mailing Address - Fax:515-643-8804
Practice Address - Street 1:1350 DES MOINES ST STE 100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-5507
Practice Address - Country:US
Practice Address - Phone:515-643-4915
Practice Address - Fax:515-643-8804
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF07221383207Q00000X
IAA170558363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine