Healthcare Provider Details

I. General information

NPI: 1174991491
Provider Name (Legal Business Name): JENNA MEIERDIERCKS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18310 MONTGOMERY VILLAGE AVE STE 460
GAITHERSBURG MD
20879-3565
US

IV. Provider business mailing address

11161 NEW HAMPSHIRE AVE STE 301
SILVER SPRING MD
20904-2606
US

V. Phone/Fax

Practice location:
  • Phone: 301-977-4100
  • Fax: 855-885-1472
Mailing address:
  • Phone: 301-681-7101
  • Fax: 855-885-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR253352
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: