Healthcare Provider Details

I. General information

NPI: 1750408852
Provider Name (Legal Business Name): JENNIFER ELIZABETH OSTRUM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

9964 S WAGSTAFF CIR
RICHMOND VA
23236-3814
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5000
  • Fax:
Mailing address:
  • Phone: 804-674-5921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number0001148691
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: