1386865004 NPI number — REBEKAH JOHANNAH ALLEN RN, FNP

Table of content: REBEKAH JOHANNAH ALLEN RN, FNP (NPI 1386865004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386865004 NPI number — REBEKAH JOHANNAH ALLEN RN, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
REBEKAH
Provider Middle Name:
JOHANNAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386865004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15124
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85267-5124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-998-4673
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8181 S 48TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85044-5309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-448-6660
Provider Business Practice Location Address Fax Number:
602-894-1446
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP4340 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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