Healthcare Provider Details

I. General information

NPI: 1841125127
Provider Name (Legal Business Name): MAYA MEMOLO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 O ST NE
WASHINGTON DC
20057-0001
US

IV. Provider business mailing address

3700 O ST NE
WASHINGTON DC
20057-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-0100
  • Fax:
Mailing address:
  • Phone: 202-687-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number292760
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN500019995
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: