Healthcare Provider Details

I. General information

NPI: 1992560411
Provider Name (Legal Business Name): ALLUN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 PHILADELPHIA RD
JOPPA MD
21085-3216
US

IV. Provider business mailing address

1518 PHILADELPHIA RD
JOPPA MD
21085-3216
US

V. Phone/Fax

Practice location:
  • Phone: 240-705-3324
  • Fax:
Mailing address:
  • Phone: 240-705-3324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SONITA NULLA
Title or Position: OWNER
Credential:
Phone: 240-705-3324