Healthcare Provider Details

I. General information

NPI: 1326546912
Provider Name (Legal Business Name): JIAO FENG NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 HUNGERFORD DR STE 40A
ROCKVILLE MD
20850-1753
US

IV. Provider business mailing address

9708 DILSTON RD
SILVER SPRING MD
20903-1915
US

V. Phone/Fax

Practice location:
  • Phone: 301-838-5955
  • Fax: 301-838-5956
Mailing address:
  • Phone: 301-655-8218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR207902
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR207092
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: