Provider Demographics
NPI:1821125295
Name:ALLEN, JUANITA (FNP)
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 S. HAMMIBAL
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106
Mailing Address - Country:US
Mailing Address - Phone:801-963-1880
Mailing Address - Fax:801-963-1886
Practice Address - Street 1:3451 S 5600 W
Practice Address - Street 2:SUITE E
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-1301
Practice Address - Country:US
Practice Address - Phone:801-963-1880
Practice Address - Fax:801-963-1886
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2083974405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQ49841Medicare UPIN