Healthcare Provider Details

I. General information

NPI: 1811223357
Provider Name (Legal Business Name): JENNIFER FUQUAY CRANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2009
Last Update Date: 10/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12022 STARBOARD DR APT 304
RESTON VA
20194-4370
US

IV. Provider business mailing address

12022 STARBOARD DR APT 304
RESTON VA
20194-4370
US

V. Phone/Fax

Practice location:
  • Phone: 703-282-5923
  • Fax:
Mailing address:
  • Phone: 703-282-5923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: