Healthcare Provider Details

I. General information

NPI: 1942202353
Provider Name (Legal Business Name): ALLEN VAUGHAN PRETTYMAN N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 S LA CANADA DR
GREEN VALLEY AZ
85614-1945
US

IV. Provider business mailing address

2800 E AJO WAY
TUCSON AZ
85713-6204
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-8888
  • Fax: 520-575-2476
Mailing address:
  • Phone: 520-694-8888
  • Fax: 520-575-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG0000129
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7965
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: