Healthcare Provider Details

I. General information

NPI: 1568405819
Provider Name (Legal Business Name): JANE ELAINE JACKNEWITZ-WOOLARD RN, DNP, CS, P/FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

13517 COACHLAMP LN
SILVER SPRING MD
20906-5836
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-8720
  • Fax: 13-192-4203
Mailing address:
  • Phone: 301-460-5578
  • Fax: 202-782-3850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR086221
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR086221
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR086221
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: