MEDICARE: MS. DESERET DAY ALLEN DNP, APRN, 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	377163-4405	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	377163-4405	OTHER	UT	UTAH DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING

General Provider Information

NPI Number	:	1891369732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DESERET DAY ALLEN DNP, APRN, FNP-BC

Provider Business Mailing Address
First Line	:	209 E GORDON AVE STE 1&2
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-2341
Country	:	US
Telephone Number	:	385-786-6100
Fax Number	:	385-786-6102

Provider Business Practice Location Address
First Line	:	209 E GORDON AVE STE 1
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-2357
Country	:	US
Telephone Number	:	801-941-9280
Fax Number	:

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

Provider Enumeration Date	:	05/15/2021
Last Update Date	:	11/08/2022

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