Healthcare Provider Details

I. General information

NPI: 1497198550
Provider Name (Legal Business Name): JENNIFER PUKISH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JENNIFER DOWNING

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SAM PERRY BLVD
FREDERICKSBURG VA
22401-4453
US

IV. Provider business mailing address

3100 SPRING FOREST RD STE 130
RALEIGH NC
27616-2880
US

V. Phone/Fax

Practice location:
  • Phone: 540-741-1100
  • Fax:
Mailing address:
  • Phone: 919-882-0774
  • Fax: 844-454-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101263877
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: