Provider Demographics
NPI:1396086260
Name:HOTTENSTEIN, MARJORIE (CRNP)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:HOTTENSTEIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:
Other - Last Name:HOTTENSTEIN/ DEANGELO/ SUPRUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:US DEPARTMENT OF STATE BUREAU OF MEDICAL SERVICES
Mailing Address - Street 2:2401 E ST NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20522-0102
Mailing Address - Country:US
Mailing Address - Phone:771-204-0546
Mailing Address - Fax:
Practice Address - Street 1:US DEPARTMENT OF STATE BUREAU OF MEDICAL SERVICES
Practice Address - Street 2:2401 E ST NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20522-0102
Practice Address - Country:US
Practice Address - Phone:771-204-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-02
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP500013367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily