Basic Information
| Provider Information | |||||||||
| NPI: | 1003320359 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTENEGRO | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | MARCELA | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 W REDWOOD ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6672141720 | ||||||||
| FaxNumber: | 4107066976 | ||||||||
| Practice Location | |||||||||
| Address1: | 16 S EUTAW ST FL 1 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103285408 | ||||||||
| FaxNumber: | 4103281909 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2017 | ||||||||
| LastUpdateDate: | 10/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R180269 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.