Healthcare Provider Details

I. General information

NPI: 1306024807
Provider Name (Legal Business Name): JENNIFER E WASHINGTON RN-CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 W RIDGEWOOD AVE
PLEASANTVILLE NJ
08232-3740
US

IV. Provider business mailing address

PO BOX 494
NORTHFIELD NJ
08225-0494
US

V. Phone/Fax

Practice location:
  • Phone: 609-646-2362
  • Fax: 609-646-1241
Mailing address:
  • Phone: 609-646-2362
  • Fax: 609-646-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26N005587800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: