Provider Demographics
NPI:1750745972
Name:ALLEN, AMANDA JANE (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E EVA ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2526
Mailing Address - Country:US
Mailing Address - Phone:602-870-6374
Mailing Address - Fax:
Practice Address - Street 1:303 E EVA ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2526
Practice Address - Country:US
Practice Address - Phone:602-870-6374
Practice Address - Fax:602-331-5730
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN130950163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse