Healthcare Provider Details

I. General information

NPI: 1295177293
Provider Name (Legal Business Name): LEORA MICHELLE ALLEN AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 MONTROSE RD UNIT 206
ROCKVILLE MD
20852-4803
US

IV. Provider business mailing address

6121 MONTROSE RD
ROCKVILLE MD
20852-4803
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-8377
  • Fax: 301-816-7716
Mailing address:
  • Phone: 301-770-8377
  • Fax: 301-816-7716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN1043287
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024179747
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAC006212
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: