Provider Demographics
NPI:1275536856
Name:FETTER, MARIE R (CNM, NP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:R
Last Name:FETTER
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8709 FLOWER AVE
Mailing Address - Street 2:MARYS CENTER
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4035
Mailing Address - Country:US
Mailing Address - Phone:240-485-3175
Mailing Address - Fax:
Practice Address - Street 1:8709 FLOWER AVE
Practice Address - Street 2:MARYS CENTER
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4035
Practice Address - Country:US
Practice Address - Phone:240-485-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR101329367A00000X, 363LW0102X
DCRN1013418367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health