Provider Demographics
NPI:1538729488
Name:MARI, ANGELA (CNS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MARI
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 OAKTREE CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1536
Mailing Address - Country:US
Mailing Address - Phone:301-676-5675
Mailing Address - Fax:
Practice Address - Street 1:1690 OAKTREE CT
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20194-1536
Practice Address - Country:US
Practice Address - Phone:703-679-7958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist