Provider Demographics
NPI:1699584060
Name:GRANT, ANDREA LEANORIA (FNP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LEANORIA
Last Name:GRANT
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9369 HIGHLANDER BLVD
Mailing Address - Street 2:
Mailing Address - City:WALKERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21793-9114
Mailing Address - Country:US
Mailing Address - Phone:301-730-1442
Mailing Address - Fax:
Practice Address - Street 1:100 S CENTER ST
Practice Address - Street 2:
Practice Address - City:THURMONT
Practice Address - State:MD
Practice Address - Zip Code:21788-1945
Practice Address - Country:US
Practice Address - Phone:301-696-8801
Practice Address - Fax:301-696-0186
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2024097620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily