Healthcare Provider Details

I. General information

NPI: 1336880756
Provider Name (Legal Business Name): ELIZABETH ANN ALLEN CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21300 N JOHN WAYNE PKWY STE 112
MARICOPA AZ
85139-8964
US

IV. Provider business mailing address

5830 S CLARK DR
TEMPE AZ
85283-2349
US

V. Phone/Fax

Practice location:
  • Phone: 520-568-9500
  • Fax:
Mailing address:
  • Phone: 480-251-9392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRNP272642
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: