Provider Demographics
NPI:1942202353
Name:PRETTYMAN, ALLEN VAUGHAN (NP)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:VAUGHAN
Last Name:PRETTYMAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 N MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0203
Mailing Address - Country:US
Mailing Address - Phone:520-621-1995
Mailing Address - Fax:520-626-6424
Practice Address - Street 1:1305 N MARTIN AVE
Practice Address - Street 2:UA NURSING & HEALTH ASSOCIATES
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0203
Practice Address - Country:US
Practice Address - Phone:520-621-1995
Practice Address - Fax:520-626-6424
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000129363LF0000X
AZAP7965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE11251386OtherCAQH
DES68549Medicare UPIN