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General NPI Number Information
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NPI Number | 1639845118
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Entity Type | Individual
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Provider Name | JENNIFER L WILLSON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 29466 PINTAIL DR STE 8
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City | EASTON
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State | MD
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Zip | 21601-9324
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Country | US
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Telephone | 443-496-3050
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 WOODLEY RD NW UNIT 114
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City | WASHINGTON
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State | DC
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Zip | 20008-4147
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AC004554
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NP500004040
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License Number State | DC
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