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Leanne Andrea Genota Antioquia

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

14300 Gallant Fox Ln Ste 110, Bowie, MD 20715-4031

PECOS Enrollment

This provider is enrolled in PECOS as LEANNE ANDREA ANTIOQUIA.

Based on the most recent information from CMS, provider Leanne Andrea Genota Antioquia is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 9:43 AM.

Profile Details

Provider ID
1215540497
Provider Type
Individual
Full Name
Antioquia, Leanne Andrea Genota
Credential
CRNP

Gender
Female
Sole Proprietor
Yes
Enumeration Date
8/26/2020
Last Updated
1/18/2021

Contact Information

Practice Location

14300 Gallant Fox Ln Ste 110, Bowie, MD 20715-4031

(301) 262-6797

Unlisted Fax

Mailing Location

14300 Gallant Fox Ln Ste 110, Bowie, MD 20715-4031

(301) 262-6797

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License R225017 Maryland

Leanne Andrea Genota Antioquia

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

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Description

License

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