Healthcare Provider Details

I. General information

NPI: 1750017174
Provider Name (Legal Business Name): DENISE LANETTE ALLGOOD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S HIGHWAY 99
FILLMORE UT
84631-5134
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-743-5555
  • Fax:
Mailing address:
  • Phone: 435-743-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number267376-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: