Provider Demographics
NPI:1639224934
Name:ALLEN, NANCE LEE (MPH, MS, APRN)
Entity Type:Individual
Prefix:
First Name:NANCE
Middle Name:LEE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MPH, MS, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5512
Mailing Address - Country:US
Mailing Address - Phone:801-487-2889
Mailing Address - Fax:
Practice Address - Street 1:3191 VALLEY ST
Practice Address - Street 2:STE #210
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84109-4274
Practice Address - Country:US
Practice Address - Phone:801-487-2889
Practice Address - Fax:801-487-0859
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4910921-4405363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health