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General NPI Number Information
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NPI Number | 1508259904
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Entity Type | Individual
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Provider Name | JILL FENTON APRN, AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 3800 RESERVOIR RD NW 2-PHC
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City | WASHINGTON
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State | DC
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Zip | 20007-2113
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Country | US
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Telephone | 202-444-8849
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Fax | 301-306-8583
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Provider Business Mailing Address
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Address Line | 3800 RESERVOIR RD NW 2-PHC
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City | WASHINGTON
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State | DC
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Zip | 20007-2113
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Country | US
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Telephone | 202-444-8849
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Fax | 301-306-8583
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1037092
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License Number State | DC
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