Healthcare Provider Details

I. General information

NPI: 1699584060
Provider Name (Legal Business Name): ANDREA LEANORIA GRANT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S CENTER ST
THURMONT MD
21788-1945
US

IV. Provider business mailing address

9369 HIGHLANDER BLVD
WALKERSVILLE MD
21793-9114
US

V. Phone/Fax

Practice location:
  • Phone: 301-696-8801
  • Fax: 301-696-0186
Mailing address:
  • Phone: 301-730-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024097620
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: