Healthcare Provider Details

I. General information

NPI: 1477950814
Provider Name (Legal Business Name): JENNIFER ANTELO MARTINEC RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 FENTON ST SUITE 1200
SILVER SPRING MD
20910-3806
US

IV. Provider business mailing address

8630 FENTON ST SUITE 1204
SILVER SPRING MD
20910-3806
US

V. Phone/Fax

Practice location:
  • Phone: 301-585-1250
  • Fax: 301-585-6289
Mailing address:
  • Phone: 301-340-7525
  • Fax: 240-499-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR210889
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: