Healthcare Provider Details

I. General information

NPI: 1730433327
Provider Name (Legal Business Name): MRS. JENNIFER KATHLEEN GARCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2012
Last Update Date: 11/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5732 READING AVE APT. 71
ALEXANDRIA VA
22311-5732
US

IV. Provider business mailing address

5732 READING AVE APT. 71
ALEXANDRIA VA
22311-5732
US

V. Phone/Fax

Practice location:
  • Phone: 703-395-7834
  • Fax:
Mailing address:
  • Phone: 703-395-7834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2282537
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: