Healthcare Provider Details

I. General information

NPI: 1023973161
Provider Name (Legal Business Name): JENNIFER DIEFENDORF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BEAVER RUN CT
WESTMINSTER MD
21157-7255
US

IV. Provider business mailing address

320 BEAVER RUN CT
WESTMINSTER MD
21157-7255
US

V. Phone/Fax

Practice location:
  • Phone: 443-992-3272
  • Fax:
Mailing address:
  • Phone: 443-992-3272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: