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General NPI Number Information
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NPI Number | 1467011288
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Entity Type | Individual
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Provider Name | JENNIFER STEPHANIE JIMENEZ DPM
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Gender | Female
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 3301 WOODBURN RD STE 208
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City | ANNANDALE
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State | VA
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Zip | 22003-1200
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Country | US
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Telephone | 703-942-9845
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Fax | 703-560-1329
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Provider Business Mailing Address
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Address Line | GEISINGER MEDICAL CENTER 100 NORTH ACADEMY AVENUE
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City | DANVILLE
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State | PA
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Zip | 17822-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0103301345
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License Number State | VA
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