MEDICARE: AMANDA DELORES ALLISON

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1811334212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA DELORES ALLISON

Provider Business Mailing Address
First Line	:	7525 REDWOOD POINT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-5434
Country	:	US
Telephone Number	:	408-421-3328
Fax Number	:

Provider Business Practice Location Address
First Line	:	7525 REDWOOD POINT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-5434
Country	:	US
Telephone Number	:	408-421-3328
Fax Number	:

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

Provider Enumeration Date	:	05/27/2013
Last Update Date	:	07/01/2013

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Directions to “ AMANDA DELORES ALLISON ” Practice Location

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