Basic Information
| Provider Information | |||||||||
| NPI: | 1386046175 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLIE | ||||||||
| FirstName: | ADMIRE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6916 SAINT ANNES AVE | ||||||||
| Address2: | |||||||||
| City: | LANHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207063400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404359420 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6856 EASTERN AVE NW # NV | ||||||||
| Address2: | STE 220 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200122165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025456980 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2014 | ||||||||
| LastUpdateDate: | 09/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LPN1006600 | DC | Y | Nursing Service Providers | Licensed Practical Nurse |
ID Information
| ID | Type | State | Issuer | Description | 4507 | 05 | DC | MEDICAID |