Healthcare Provider Details

I. General information

NPI: 1558777037
Provider Name (Legal Business Name): JENNA FEWINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date: 05/29/2018
Reactivation Date: 06/20/2018

III. Provider practice location address

4494 PALMER RD N
BETHESDA MD
20814
US

IV. Provider business mailing address

4494 PALMER RD N
BETHESDA MD
20814
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number2901021801
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: