Healthcare Provider Details

I. General information

NPI: 1629585450
Provider Name (Legal Business Name): JENNIFER L RAYMOND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARTHA JEFFERSON DR
CHARLOTTESVILLE VA
22911
US

IV. Provider business mailing address

PO BOX 79777
BALTIMORE MD
21279-0777
US

V. Phone/Fax

Practice location:
  • Phone: 434-654-8390
  • Fax: 434-654-8399
Mailing address:
  • Phone: 434-654-7794
  • Fax: 434-654-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024175675
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: