Basic Information
| Provider Information | |||||||||
| NPI: | 1942202353 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRETTYMAN | ||||||||
| FirstName: | ALLEN | ||||||||
| MiddleName: | VAUGHAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | N.P. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1305 N MARTIN AVE | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857210203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206211995 | ||||||||
| FaxNumber: | 5206266424 | ||||||||
| Practice Location | |||||||||
| Address1: | 1305 N MARTIN AVE | ||||||||
| Address2: | UA NURSING & HEALTH ASSOCIATES | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857210203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206211995 | ||||||||
| FaxNumber: | 5206266424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | LG0000129 | DE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | AP7965 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 11251386 | 01 | DE | CAQH | OTHER |