Provider Demographics
NPI:1942202353
Name:PRETTYMAN, ALLEN VAUGHAN (NP)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:VAUGHAN
Last Name:PRETTYMAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 E AJO WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-6204
Mailing Address - Country:US
Mailing Address - Phone:520-694-8888
Mailing Address - Fax:520-575-2476
Practice Address - Street 1:1141 S LA CANADA DR
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-1945
Practice Address - Country:US
Practice Address - Phone:520-694-8888
Practice Address - Fax:520-575-2476
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000129363LF0000X
AZAP7965363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE11251386OtherCAQH
DES68549Medicare UPIN