MEDICARE: ALLISON WOOLLEY LUDLOW NP-C

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	197716-4405	UT

General Provider Information

NPI Number	:	1083987358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON WOOLLEY LUDLOW NP-C

Provider Business Mailing Address
First Line	:	PO BOX 100
Second Line	:	WEST CEMETERY ROAD
City	:	PLYMOUTH
State	:	UT
Zip	:	84330-0100
Country	:	US
Telephone Number	:	435-458-2404
Fax Number	:	435-458-2361

Provider Business Practice Location Address
First Line	:	7285 W 21200 N
Second Line	:
City	:	PLYMOUTH
State	:	UT
Zip	:	84330-0100
Country	:	US
Telephone Number	:	435-458-2404
Fax Number	:	435-458-2361

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

Provider Enumeration Date	:	02/17/2012
Last Update Date	:	02/17/2012

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