Healthcare Provider Details

I. General information

NPI: 1710824313
Provider Name (Legal Business Name): ANNA G ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 W 61ST ST APT D
WESTMONT IL
60559-2767
US

IV. Provider business mailing address

527 W 61ST ST APT D
WESTMONT IL
60559-2767
US

V. Phone/Fax

Practice location:
  • Phone: 575-749-4113
  • Fax:
Mailing address:
  • Phone: 231-330-6595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: