Provider Demographics
NPI:1699058800
Name:ALLEN, VICKY LYNN
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:LYNN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 COLBY CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-4001
Mailing Address - Country:US
Mailing Address - Phone:702-556-5445
Mailing Address - Fax:702-597-2242
Practice Address - Street 1:3504 COLBY CREEK AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-4001
Practice Address - Country:US
Practice Address - Phone:702-556-5445
Practice Address - Fax:702-597-2242
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner