Basic Information
Provider Information
NPI: 1053762658
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLBEE
FirstName: ANNE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MPA, RD, PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13460 N 94TH DR STE J1
Address2:  
City: PEORIA
State: AZ
PostalCode: 853814246
CountryCode: US
TelephoneNumber: 6238768816
FaxNumber: 6232980168
Practice Location
Address1: 13460 N 94TH DR STE J1
Address2:  
City: PEORIA
State: AZ
PostalCode: 853814246
CountryCode: US
TelephoneNumber: 6238768816
FaxNumber: 6232980168
Other Information
ProviderEnumerationDate: 06/24/2016
LastUpdateDate: 08/04/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/04/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000X2015001153MON Dietary & Nutritional Service ProvidersDietitian, Registered 
363A00000X  Y Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


Home