Healthcare Provider Details

I. General information

NPI: 1326963554
Provider Name (Legal Business Name): AMY LYNN PALLESEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 S LAMB RD
CASA GRANDE AZ
85193-9035
US

IV. Provider business mailing address

2503 S LAMB RD
CASA GRANDE AZ
85193-9035
US

V. Phone/Fax

Practice location:
  • Phone: 307-389-2323
  • Fax:
Mailing address:
  • Phone: 307-389-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9005437-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: