Provider Demographics
NPI:1215584271
Name:ALLAN, PROMISE C (NP)
Entity Type:Individual
Prefix:
First Name:PROMISE
Middle Name:C
Last Name:ALLAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 W PADONIA RD STE C252
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2241
Mailing Address - Country:US
Mailing Address - Phone:410-989-1944
Mailing Address - Fax:
Practice Address - Street 1:22 W PADONIA RD STE C252
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2241
Practice Address - Country:US
Practice Address - Phone:410-989-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2022-04-25
Deactivation Date:2022-03-17
Deactivation Code:
Reactivation Date:2022-04-25
Provider Licenses
StateLicense IDTaxonomies
MDR203070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily