MEDICARE: MARIE R. FETTER C.N.M., N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	R101329	MD
2	363LW0102X	Women's Health Nurse Practitioner	R101329	MD
3	367A00000X	Advanced Practice Midwife	RN1013418	DC

General Provider Information

NPI Number	:	1275536856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE R. FETTER C.N.M., N.P.

Provider Business Mailing Address
First Line	:	8709 FLOWER AVE
Second Line	:	MARYS CENTER
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-4035
Country	:	US
Telephone Number	:	240-485-3175
Fax Number	:

Provider Business Practice Location Address
First Line	:	8709 FLOWER AVE
Second Line	:	MARYS CENTER
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-4035
Country	:	US
Telephone Number	:	240-485-3175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/29/2011

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