IndividualActive
Allen Wallace, CRNA
NPI 1295798163 · Certified Registered Nurse Anesthetist · Roosevelt, UT
Provider details
- NPI number
- 1295798163
- Entity type
- Individual
- Primary specialty
- Certified Registered Nurse AnesthetistPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- CRNA
- Sex
- Male
- Sole proprietor
- No
- License
- 192839-4406 (UT)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
250 W 300 N
Roosevelt, UT 84066-2336
Phone: (435) 722-6163
Fax: (435) 722-9291
Approximate (ZIP-level) locationGet directions
Mailing address
250 W 300 N
Roosevelt, UT 84066-2336
Registry dates
- Enumerated
- 2006-04-10
- Last updated
- 2007-11-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.