MEDICARE: NANCE LEE ALLEN MPH, MS, APRN

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	363LA2200X	Adult Health Nurse Practitioner	4910921-4405	UT

General Provider Information

NPI Number	:	1639224934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCE LEE ALLEN MPH, MS, APRN

Provider Business Mailing Address
First Line	:	2700 KENTUCKY AVE
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84117-5512
Country	:	US
Telephone Number	:	801-487-2889
Fax Number	:

Provider Business Practice Location Address
First Line	:	3191 VALLEY ST
Second Line	:	STE #210
City	:	SLC
State	:	UT
Zip	:	84109-4274
Country	:	US
Telephone Number	:	801-487-2889
Fax Number	:	801-487-0859

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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