Provider Demographics
NPI:1023503174
Name:ALLEN, RAYMOND WILLIAM (APRN, MSN)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:WILLIAM
Last Name:ALLEN
Suffix:
Gender:M
Credentials:APRN, MSN
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:W
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:971 W 1200 S
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087-2007
Mailing Address - Country:US
Mailing Address - Phone:801-891-7261
Mailing Address - Fax:
Practice Address - Street 1:971 W 1200 S
Practice Address - Street 2:
Practice Address - City:WOODS CROSS
Practice Address - State:UT
Practice Address - Zip Code:84087-2007
Practice Address - Country:US
Practice Address - Phone:801-891-7261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5149296-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5149296-8900OtherAPRN WITH CONTROLLED SUBSTANCES
UT5149296-4405OtherAPRN
UT1992004001OtherPARAMEDIC
UT5149296-3102OtherREGISTERED NURSE