Provider Demographics
NPI:1801146345
Name:ALLRED, ALICE R TETZKE (EMT)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:R TETZKE
Last Name:ALLRED
Suffix:
Gender:F
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1016
Mailing Address - Country:US
Mailing Address - Phone:480-497-4034
Mailing Address - Fax:480-507-1645
Practice Address - Street 1:55 N GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-6220
Practice Address - Country:US
Practice Address - Phone:480-497-4034
Practice Address - Fax:480-507-1624
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44635146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic