Healthcare Provider Details

I. General information

NPI: 1033596036
Provider Name (Legal Business Name): ALFREDIA-PRINCELLA ALLEN CPT, CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 W ALEXANDER RD UNIT 2041
NORTH LAS VEGAS NV
89032-9053
US

IV. Provider business mailing address

1881 W. AEXANDER RD. UNIT # 2041
NORTH LAS VEGAS NV
89032
US

V. Phone/Fax

Practice location:
  • Phone: 708-639-5563
  • Fax:
Mailing address:
  • Phone: 708-639-5563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number13-2884
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: