Healthcare Provider Details

I. General information

NPI: 1851116651
Provider Name (Legal Business Name): JAEMIE KATIPUNAN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 RAINTREE RD
CHESAPEAKE VA
23321-3741
US

IV. Provider business mailing address

4721 BERRYWOOD RD
VIRGINIA BEACH VA
23464-5869
US

V. Phone/Fax

Practice location:
  • Phone: 757-488-2223
  • Fax:
Mailing address:
  • Phone: 757-515-1232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024191684
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: