MEDICARE: LARONDA MORENIKE ALLEN NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704259609	MI

General Provider Information

NPI Number	:	1841857885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARONDA MORENIKE ALLEN NP-C

Provider Business Mailing Address
First Line	:	18272 NEW HAMPSHIRE DR
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-8102
Country	:	US
Telephone Number	:	313-433-2328
Fax Number	:

Provider Business Practice Location Address
First Line	:	8575 HERITAGE PL
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-2326
Country	:	US
Telephone Number	:	313-977-0962
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2019
Last Update Date	:	05/07/2025

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