Healthcare Provider Details

I. General information

NPI: 1669616587
Provider Name (Legal Business Name): DESIREE ELIZABETH ALLYN FNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 CHURCHILL DOWNS CT
WALNUT CREEK CA
94597-7600
US

IV. Provider business mailing address

572 CHURCHILL DOWNS CT
WALNUT CREEK CA
94597-7600
US

V. Phone/Fax

Practice location:
  • Phone: 925-933-3888
  • Fax:
Mailing address:
  • Phone: 925-933-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: