MEDICARE: NATALIE HOLT ALLEN FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	217280-4405	UT

General Provider Information

NPI Number	:	1649605601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE HOLT ALLEN FNP-BC

Provider Business Mailing Address
First Line	:	127 S. 500 E
Second Line	:	SUITE 600
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1971
Country	:	US
Telephone Number	:	801-587-6336
Fax Number	:	801-715-8228

Provider Business Practice Location Address
First Line	:	44 N MARIO CAPECCHI DR.
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84114
Country	:	US
Telephone Number	:	801-584-8246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	08/10/2015

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