Healthcare Provider Details

I. General information

NPI: 1114998085
Provider Name (Legal Business Name): MARIAN L ENGLE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE OB/GYN CLINIC
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

12105 ELM FOREST WAY APT L
FAIRFAX VA
22030-7732
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-5455
  • Fax: 301-319-8276
Mailing address:
  • Phone: 703-802-7318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF420409-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: