Provider Demographics
NPI:1003320359
Name:MONTENEGRO, MARIA MARCELA (CRNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:MARCELA
Last Name:MONTENEGRO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:306 W REDWOOD ST FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1708
Mailing Address - Country:US
Mailing Address - Phone:667-214-1720
Mailing Address - Fax:410-706-6976
Practice Address - Street 1:16 S EUTAW ST FL 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1606
Practice Address - Country:US
Practice Address - Phone:410-328-5408
Practice Address - Fax:410-328-1909
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-24
Last Update Date:2018-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR180269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily