Healthcare Provider Details

I. General information

NPI: 1396086260
Provider Name (Legal Business Name): MARJORIE HOTTENSTEIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARJORIE HOTTENSTEIN/ DEANGELO/ SUPRUM CRNP

II. Dates (important events)

Enumeration Date: 03/02/2013
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US DEPARTMENT OF STATE BUREAU OF MEDICAL SERVICES 2401 E ST NW
WASHINGTON DC
20522-0102
US

IV. Provider business mailing address

US DEPARTMENT OF STATE BUREAU OF MEDICAL SERVICES 2401 E ST NW
WASHINGTON DC
20522-0102
US

V. Phone/Fax

Practice location:
  • Phone: 771-204-0546
  • Fax:
Mailing address:
  • Phone: 771-204-0546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP500013367
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: