Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R180269 | MD |
NPI | 1003320359 |
---|---|
Provider Name | Maria Marcela Montenegro |
First Address | Baltimore, MD 21201-1708 |
Second Address | Baltimore, MD 21201-1606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2017 |
Last Update Date | 25/10/2018 |