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General NPI Number Information
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NPI Number | 1689180697
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Entity Type | Individual
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Provider Name | JENNIFER WALDRON
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Gender | Female
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 12/28/2017
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Provider Practice Location Address
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Address Line | 6323 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20011-1101
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Country | US
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Telephone | 202-506-1209
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Fax |
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Provider Business Mailing Address
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Address Line | 6323 GEORGIA AVE NW STE 106
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City | WASHINGTON
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State | DC
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Zip | 20011-1101
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN45943
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License Number State | DC
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