Healthcare Provider Details

I. General information

NPI: 1770619181
Provider Name (Legal Business Name): JUANITA DENISE ALLEN-HECKSTALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 COLONIAL LN
SILVER SPRING MD
20910-5721
US

IV. Provider business mailing address

14705 VAN WAGNER RD
UPPER MARLBORO MD
20772-9715
US

V. Phone/Fax

Practice location:
  • Phone: 301-585-1250
  • Fax: 301-585-6289
Mailing address:
  • Phone: 301-952-1188
  • Fax: 301-952-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR157318
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: