Healthcare Provider Details

I. General information

NPI: 1194711077
Provider Name (Legal Business Name): JENNIFER NAU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14370 LEE HWY SUITE 105
GAINESVILLE VA
20155-4865
US

IV. Provider business mailing address

14370 LEE HWY SUITE 105
GAINESVILLE VA
20155-4865
US

V. Phone/Fax

Practice location:
  • Phone: 703-754-4101
  • Fax: 703-754-1105
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101059328
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: