# NICOLAS J. ALLEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1205910551
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA644 | ID | Yes |

## Other

- **Enumeration date:** 10/24/2006
- **Last updated:** 11/10/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010159170 | BLUE SHIELD MERIDIAN | ID |
| 01 | — | 000010159171 | BLUE SHIELD BOISE | ID |
| 01 | — | PAD82 | BLUE CROSS MERIDIAN | ID |