Healthcare Provider Details

I. General information

NPI: 1437096294
Provider Name (Legal Business Name): KAREN ALEJANDRA CORNEJO ALVARENGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8419 OAK MEADE WAY
JESSUP MD
20794-3411
US

IV. Provider business mailing address

8419 OAK MEADE WAY
JESSUP MD
20794-3411
US

V. Phone/Fax

Practice location:
  • Phone: 443-401-5505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR245684
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: