Healthcare Provider Details

I. General information

NPI: 1043908973
Provider Name (Legal Business Name): JENNIFER KNOWLTON MSN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 12/24/2023
Certification Date: 12/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON PLZ STE 103
CHESAPEAKE VA
23320-5179
US

IV. Provider business mailing address

1101 MADISON PLZ STE 103
CHESAPEAKE VA
23320-5179
US

V. Phone/Fax

Practice location:
  • Phone: 757-436-4111
  • Fax:
Mailing address:
  • Phone: 757-436-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number0001178538
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024188453
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: