Provider Demographics
NPI:1801287115
Name:HUNDERTMARK, ISAURA
Entity type:Individual
Prefix:
First Name:ISAURA
Middle Name:
Last Name:HUNDERTMARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ISAURA
Other - Middle Name:TERESA
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8630 FENTON ST
Mailing Address - Street 2:SUITE 1204
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:301-340-7525
Mailing Address - Fax:240-499-2636
Practice Address - Street 1:7676 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 220A
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7512
Practice Address - Country:US
Practice Address - Phone:301-431-2972
Practice Address - Fax:301-439-0008
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT20150038163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse