Healthcare Provider Details

I. General information

NPI: 1770510448
Provider Name (Legal Business Name): JUDITH LU ALLEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 UPTOWN BLVD NE
ALBUQUERQUE NM
87110-4163
US

IV. Provider business mailing address

14 CAMINO OJO DE LA CASA
PLACITAS NM
87043-8692
US

V. Phone/Fax

Practice location:
  • Phone: 505-340-0700
  • Fax: 505-340-0701
Mailing address:
  • Phone: 505-404-8094
  • Fax: 505-404-8353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR19305
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: