Provider Demographics
NPI:1205645892
Name:ALLEN, SAMANTHA ELISE (CNIM)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ELISE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 E 3250 N
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-1773
Mailing Address - Country:US
Mailing Address - Phone:307-333-3161
Mailing Address - Fax:
Practice Address - Street 1:9825 N 10800 W
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-9222
Practice Address - Country:US
Practice Address - Phone:801-643-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic