Provider Demographics
NPI:1770911448
Name:ALLRED, DIANE W (FNP)
Entity type:Individual
Prefix:MR
First Name:DIANE
Middle Name:W
Last Name:ALLRED
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 E 3200 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5464
Mailing Address - Country:US
Mailing Address - Phone:801-407-3000
Mailing Address - Fax:801-407-3301
Practice Address - Street 1:1175 E 3200 N
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5464
Practice Address - Country:US
Practice Address - Phone:801-407-3000
Practice Address - Fax:801-407-3301
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT197201-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner