Healthcare Provider Details

I. General information

NPI: 1366197741
Provider Name (Legal Business Name): MARIE ALEXANDRA PRYOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW FL 5
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

3300 E WEST HWY APT 345
HYATTSVILLE MD
20782-2180
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2500
  • Fax:
Mailing address:
  • Phone: 540-793-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR244081
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP1047215
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: