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NPI Code Detail

MEDICARE: MRS. JUANITA DENISE ALLEN-HECKSTALL NP

MEDICARE: MRS. JUANITA DENISE ALLEN-HECKSTALL NP
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
1363LF0000XFamily Nurse PractitionerR157318MD

General Provider Information

NPI Number : 1770619181
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JUANITA DENISE ALLEN-HECKSTALL NP
Provider Business Mailing Address
First Line : 14705 VAN WAGNER RD
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20772-9715
Country : US
Telephone Number : 301-952-1188
Fax Number : 301-952-1310
Provider Business Practice Location Address
First Line : 8210 COLONIAL LN
Second Line :
City : SILVER SPRING
State : MD
Zip : 20910-5721
Country : US
Telephone Number : 301-585-1250
Fax Number : 301-585-6289
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2007
Last Update Date : 02/17/2012

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