Healthcare Provider Details

I. General information

NPI: 1003364795
Provider Name (Legal Business Name): JENNIFER JONES LANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 FRIENDSHIP BLVD STE T90
CHEVY CHASE MD
20815-7313
US

IV. Provider business mailing address

4701 SANGAMORE RD S207
BETHESDA MD
20816-2508
US

V. Phone/Fax

Practice location:
  • Phone: 240-737-0085
  • Fax:
Mailing address:
  • Phone: 202-684-7167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR219914
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1025415
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR219914
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: