Healthcare Provider Details

I. General information

NPI: 1639621741
Provider Name (Legal Business Name): ELVIA REA ALLEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 860
WHITERIVER AZ
85941-0860
US

IV. Provider business mailing address

PO BOX 860
WHITERIVER AZ
85941-0860
US

V. Phone/Fax

Practice location:
  • Phone: 928-338-4911
  • Fax:
Mailing address:
  • Phone: 928-338-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11398
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: