Healthcare Provider Details

I. General information

NPI: 1053306647
Provider Name (Legal Business Name): JEANNETTE LOIS SWEITZER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22221 WESTERNPORT RD SW
WESTERNPORT MD
21562-2206
US

IV. Provider business mailing address

1027 MEMORIAL DR
OAKLAND MD
21550-4343
US

V. Phone/Fax

Practice location:
  • Phone: 301-533-3300
  • Fax: 301-533-3299
Mailing address:
  • Phone: 301-533-3300
  • Fax: 301-533-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR08333
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR083333
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: