Healthcare Provider Details

I. General information

NPI: 1245665553
Provider Name (Legal Business Name): MARLENE SEGALL WENTWORTH NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLENE RUTH SEGALL NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO ROAD NW SUITE 340 SIBLEY MEMORIAL HOSPITAL
WASHINGTON DC
20016-2695
US

IV. Provider business mailing address

5255 LOUGHBORO ROAD NW SUITE 340
WASHINGTON DC
20016-2695
US

V. Phone/Fax

Practice location:
  • Phone: 202-537-4265
  • Fax: 202-537-4442
Mailing address:
  • Phone: 202-537-4265
  • Fax: 202-537-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberRN1026269
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: