Provider Demographics
NPI:1770510448
Name:ALLEN, JUDITH LU (CNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LU
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
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Mailing Address - Street 1:14 CAMINO OJO DE LA CASA
Mailing Address - Street 2:
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-8692
Mailing Address - Country:US
Mailing Address - Phone:505-404-8094
Mailing Address - Fax:505-404-8353
Practice Address - Street 1:6100 UPTOWN BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4163
Practice Address - Country:US
Practice Address - Phone:505-340-0700
Practice Address - Fax:505-340-0701
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMR19305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78828007Medicaid
NMR19305OtherCNP
NM78828007Medicaid
NM341417411Medicare PIN