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General NPI Number Information
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NPI Number | 1386669638
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Entity Type | Individual
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Provider Name | PHYLLIS V ALLEN NP
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 1095 MARSHALL WAY
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City | PLACERVILLE
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State | CA
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Zip | 95667-5722
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Country | US
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Telephone | 530-626-2978
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Fax |
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Provider Business Mailing Address
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Address Line | 1095 MARSHALL WAY
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City | PLACERVILLE
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State | CA
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Zip | 95667-5722
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Country | US
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Telephone | 530-626-2978
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP9911
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License Number State | CA
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