Healthcare Provider Details

I. General information

NPI: 1609193671
Provider Name (Legal Business Name): JENNIFER KATIE LANDRETTE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PENNSYLVANIA AVE SE SUITE 201
WASHINGTON DC
20003-2167
US

IV. Provider business mailing address

801 PENNSYLVANIA AVE SE SUITE 201
WASHINGTON DC
20003-2167
US

V. Phone/Fax

Practice location:
  • Phone: 202-546-1512
  • Fax: 202-544-5365
Mailing address:
  • Phone: 202-546-1512
  • Fax: 202-544-5365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR186255
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1016394
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN1016394
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: