Provider Demographics
NPI:1750366548
Name:MACLEOD, JOAN LORETTA (RN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:LORETTA
Last Name:MACLEOD
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 MALLARD DR STE 109
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3180
Mailing Address - Country:US
Mailing Address - Phone:301-776-8000
Mailing Address - Fax:
Practice Address - Street 1:9811 MALLARD DR STE 109
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3180
Practice Address - Country:US
Practice Address - Phone:301-776-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR104899363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics