Healthcare Provider Details

I. General information

NPI: 1609050608
Provider Name (Legal Business Name): DOLLA JEAN ALLISON CNS, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W 800 N SUITE 340B
OREM UT
84057-6318
US

IV. Provider business mailing address

730 W 800 N SUITE 340B
OREM UT
84057-6318
US

V. Phone/Fax

Practice location:
  • Phone: 801-655-5425
  • Fax: 801-655-5426
Mailing address:
  • Phone: 801-655-5425
  • Fax: 801-655-5426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number5557181-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberNNP 689A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: