Provider Demographics
NPI:1487023479
Name:FORTUNE, MARIA JEVON
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JEVON
Last Name:FORTUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5057 ASTOR PL SE APT 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-7683
Mailing Address - Country:US
Mailing Address - Phone:202-870-0538
Mailing Address - Fax:
Practice Address - Street 1:5057 ASTOR PL SE APT 203
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7683
Practice Address - Country:US
Practice Address - Phone:202-870-0538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-19
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist