MEDICARE: JENNIFER MELLODY DUKES CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	R132156	MD

General Provider Information

NPI Number	:	1841568904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MELLODY DUKES CRNP

Provider Business Mailing Address
First Line	:	838 N EUTAW ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-4624
Country	:	US
Telephone Number	:	410-523-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	838 N EUTAW ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201-4624
Country	:	US
Telephone Number	:	410-523-1414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	12/05/2011

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