Provider Demographics
NPI:1669616587
Name:ALLYN, DESIREE ELIZABETH (FNP, MSN)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:ELIZABETH
Last Name:ALLYN
Suffix:
Gender:F
Credentials:FNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 CHURCHILL DOWNS CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-7600
Mailing Address - Country:US
Mailing Address - Phone:925-933-3888
Mailing Address - Fax:
Practice Address - Street 1:572 CHURCHILL DOWNS CT
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-7600
Practice Address - Country:US
Practice Address - Phone:925-933-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily