Provider Demographics
NPI:1770619181
Name:ALLEN-HECKSTALL, JUANITA DENISE (NP)
Entity type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:DENISE
Last Name:ALLEN-HECKSTALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14705 VAN WAGNER RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-9715
Mailing Address - Country:US
Mailing Address - Phone:301-952-1188
Mailing Address - Fax:301-952-1310
Practice Address - Street 1:8210 COLONIAL LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5721
Practice Address - Country:US
Practice Address - Phone:301-585-1250
Practice Address - Fax:301-585-6289
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR157318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily