Healthcare Provider Details

I. General information

NPI: 1003320359
Provider Name (Legal Business Name): MARIA MARCELA MONTENEGRO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2017
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 S EUTAW ST FL 1
BALTIMORE MD
21201-1606
US

IV. Provider business mailing address

306 W REDWOOD ST FL 4
BALTIMORE MD
21201-1708
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5408
  • Fax: 410-328-1909
Mailing address:
  • Phone: 667-214-1720
  • Fax: 410-706-6976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR180269
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: