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 1:206 E BROWN ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-420-4951
Mailing Address - Fax:570-476-3754
Practice Address - Street 1:200 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-476-3700
Practice Address - Fax:570-476-3637
Is Sole Proprietor?:No
Enumeration Date:2013-03-02
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP006936B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily