MEDICARE: RAYMOND WILLIAM ALLEN APRN, MSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5149296-4405	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5149296-8900	OTHER	UT	APRN WITH CONTROLLED SUBSTANCES
2	5149296-4405	OTHER	UT	APRN
3	1992004001	OTHER	UT	PARAMEDIC
4	5149296-3102	OTHER	UT	REGISTERED NURSE

General Provider Information

NPI Number	:	1023503174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND WILLIAM ALLEN APRN, MSN

Provider Business Mailing Address
First Line	:	971 W 1200 S
Second Line	:
City	:	WOODS CROSS
State	:	UT
Zip	:	84087-2007
Country	:	US
Telephone Number	:	801-891-7261
Fax Number	:

Provider Business Practice Location Address
First Line	:	971 W 1200 S
Second Line	:
City	:	WOODS CROSS
State	:	UT
Zip	:	84087-2007
Country	:	US
Telephone Number	:	801-891-7261
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	07/08/2022

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