Provider Demographics
NPI:1124990825
Name:DEROO, ALLIE (NP)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:
Last Name:DEROO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 MILE HIGH STADIUM CIR APT 804
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2766
Mailing Address - Country:US
Mailing Address - Phone:309-912-4667
Mailing Address - Fax:
Practice Address - Street 1:1919 MILE HIGH STADIUM CIR APT 804
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2766
Practice Address - Country:US
Practice Address - Phone:309-912-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.1001160-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner