Provider Demographics
NPI:1548735921
Name:NEGRI, MAURA (NP)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:NEGRI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MAURA
Other - Middle Name:
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4200 WISCONSIN AVE NW STE 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2143
Mailing Address - Country:US
Mailing Address - Phone:202-243-3400
Mailing Address - Fax:202-243-3434
Practice Address - Street 1:4200 WISCONSIN AVE NW STE 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2143
Practice Address - Country:US
Practice Address - Phone:202-243-3400
Practice Address - Fax:202-243-3434
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176514208000000X
DCRN1032039363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty