Provider Demographics
NPI:1508573684
Name:ALLEN, ERIN (NP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:WALLSBURG
Mailing Address - State:UT
Mailing Address - Zip Code:84082-0234
Mailing Address - Country:US
Mailing Address - Phone:801-836-2601
Mailing Address - Fax:
Practice Address - Street 1:523 S 550 E
Practice Address - Street 2:
Practice Address - City:WALLSBURG
Practice Address - State:UT
Practice Address - Zip Code:84082-1203
Practice Address - Country:US
Practice Address - Phone:801-836-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT69787184405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily