Provider Demographics
NPI:1275808610
Name:PRAY, MARJORIE WATTERS (RN/NP)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:WATTERS
Last Name:PRAY
Suffix:
Gender:F
Credentials:RN/NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 EARLSTON DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1733
Mailing Address - Country:US
Mailing Address - Phone:301-229-7624
Mailing Address - Fax:
Practice Address - Street 1:9309 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1620
Practice Address - Country:US
Practice Address - Phone:301-229-7624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR049255363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care