Healthcare Provider Details

I. General information

NPI: 1275536856
Provider Name (Legal Business Name): MARIE R. FETTER C.N.M., N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8709 FLOWER AVE MARYS CENTER
SILVER SPRING MD
20901-4035
US

IV. Provider business mailing address

8709 FLOWER AVE MARYS CENTER
SILVER SPRING MD
20901-4035
US

V. Phone/Fax

Practice location:
  • Phone: 240-485-3175
  • Fax:
Mailing address:
  • Phone: 240-485-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR101329
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR101329
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN1013418
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: