Provider Demographics
NPI:1821542606
Name:ALLEN, DITTA IONIE (ANP)
Entity Type:Individual
Prefix:MS
First Name:DITTA
Middle Name:IONIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 PINE ORCHARD LN APT C
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2386
Mailing Address - Country:US
Mailing Address - Phone:877-477-4177
Mailing Address - Fax:877-477-4177
Practice Address - Street 1:3280 PINE ORCHARD LN APT C
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2386
Practice Address - Country:US
Practice Address - Phone:877-477-4177
Practice Address - Fax:877-477-4177
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR227281363LA2200X
NJ26NJ00635300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health