Healthcare Provider Details

I. General information

NPI: 1760483507
Provider Name (Legal Business Name): JENNIFER D MCPHERSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LETTERMAN

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD INOVA ALEXANDRIA HOSPITAL
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

11781 LEE JACKSON MEMORIAL HWY SUITE 550
FAIRFAX VA
22033-3309
US

V. Phone/Fax

Practice location:
  • Phone: 703-664-7048
  • Fax: 703-845-7463
Mailing address:
  • Phone: 703-295-9360
  • Fax: 703-766-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024166475
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0001195119
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: